Provider Demographics
NPI:1700825395
Name:LOGALBO, PETER (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:LOGALBO
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 1:660 WHITE PLAINS RD FL 4
Mailing Address - Street 2:
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-5139
Mailing Address - Country:US
Mailing Address - Phone:914-984-2546
Mailing Address - Fax:
Practice Address - Street 1:1 CROSFIELD AVENUE
Practice Address - Street 2:SUITE 201
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-2229
Practice Address - Country:US
Practice Address - Phone:845-727-1370
Practice Address - Fax:845-727-1377
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA054270207KA0200X
NY140894207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ607647Medicare ID - Type Unspecified
NJA63275Medicare UPIN
NY56D101Medicare ID - Type Unspecified