Provider Demographics
NPI:1629064837
Name:SYMINGTON, PETER
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:SYMINGTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 ELM ST
Mailing Address - Street 2:
Mailing Address - City:HARRINGTON PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07640-1902
Mailing Address - Country:US
Mailing Address - Phone:201-784-0123
Mailing Address - Fax:201-784-0065
Practice Address - Street 1:24 ELM ST
Practice Address - Street 2:
Practice Address - City:HARRINGTON PARK
Practice Address - State:NJ
Practice Address - Zip Code:07640-1902
Practice Address - Country:US
Practice Address - Phone:201-784-0123
Practice Address - Fax:201-784-0065
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06846400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2355615OtherAETNA HMO #
NJ5C6261OtherEMPIRE HC (HP) #
NJ7712121OtherAETNA PPO #
NJ223413838OtherTAX IDENTIFICATION #
NJ5C6262OtherEMPIRE HC (TE) #
NJ8296103OtherMEDICAID NJ #
NJ8296103Medicaid
NJP2144857OtherOXFORD #
NJ110246345OtherRAILROAD MDCR #
NJ1K7859OtherHEALTHNET #
NJ0329586000OtherAMERIHEALTH #