Provider Demographics
NPI:1811189939
Name:PEET, ROSS DEREK (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSS
Middle Name:DEREK
Last Name:PEET
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:PO BOX 270
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11762-0270
Mailing Address - Country:US
Mailing Address - Phone:631-264-2035
Mailing Address - Fax:631-264-1418
Practice Address - Street 1:1516 LEXINGTON AVE
Practice Address - Street 2:CARNEGIE HILL ENDOSCOPY
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-7102
Practice Address - Country:US
Practice Address - Phone:212-860-6300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA97856207LP3000X
NY244459207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology