Provider Demographics
NPI:1619928272
Name:MILBURN, PETER BENEDICT (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:BENEDICT
Last Name:MILBURN
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 1:8026 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-4004
Mailing Address - Country:US
Mailing Address - Phone:718-680-2800
Mailing Address - Fax:718-921-0712
Practice Address - Street 1:8026 5TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-4004
Practice Address - Country:US
Practice Address - Phone:718-680-2800
Practice Address - Fax:718-921-0712
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY137240174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0050250OtherGHI
NY137240OtherHIP
NY10022OtherHEALTHCARE PARTNERS
NM2169451OtherAETNA
NY4250586OtherAETNA
NY69789OtherUNITED HEALTHCARE
NYKS719OtherOXFORD
NM2169451OtherAETNA
NY0050250OtherGHI
NY4250586OtherAETNA