Provider Demographics
NPI:1609888668
Name:TENICKI, PETER J (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:J
Last Name:TENICKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 SHELBURNE RD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-3628
Mailing Address - Country:US
Mailing Address - Phone:203-276-7298
Mailing Address - Fax:
Practice Address - Street 1:30 SHELBURNE RD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-3628
Practice Address - Country:US
Practice Address - Phone:203-276-7298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT041551207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TINOtherGREAT WEST
TINOtherCHN SOLUTIONS
CTP3044450OtherOXFORD HEALTH PLAN
TINOtherFOCUS
TINOtherFIRST HEALTH/ CCN
TINOtherNORTHEAST HEALTH DIRECT
CT3308535OtherAETNA - HMO
CT473P62OtherEMPIRE BC/BS
CT9441583OtherCIGNA
CT010041551CT01OtherANTHEM BC/BS
CT041551OtherCONNECTICARE
CT2V4593OtherHEALTH NET
CTP00074279OtherRAILROAD MEDICARE
TINOtherPRIVATE HEALTHCARE SYSTE
TINOtherPOMCO
TINOtherUNITED HEALTHCARE
CT7267461OtherAETNA - PPO
H75644Medicare UPIN
TINOtherGREAT WEST