Provider Demographics
NPI:1730303058
Name:KORN, PETER TOBIAS (MD)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:TOBIAS
Last Name:KORN
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 1:833 NORTHERN BLVD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:GREATNECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021
Mailing Address - Country:US
Mailing Address - Phone:516-498-8400
Mailing Address - Fax:516-498-8404
Practice Address - Street 1:833 NORTHERN BLVD
Practice Address - Street 2:SUITE 160
Practice Address - City:GREATNECK
Practice Address - State:NY
Practice Address - Zip Code:11021
Practice Address - Country:US
Practice Address - Phone:516-498-8400
Practice Address - Fax:516-498-8404
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2393182086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02884471Medicaid
NY1A186CW211Medicare PIN