Provider Demographics
NPI:1841402799
Name:PETERS, ANGELA (LAC)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:
Last Name:PETERS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:LE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:1045 5TH AVE
Mailing Address - Street 2:SUITE 1-A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0138
Mailing Address - Country:US
Mailing Address - Phone:212-432-1110
Mailing Address - Fax:
Practice Address - Street 1:1045 5TH AVE
Practice Address - Street 2:SUITE 1-A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0138
Practice Address - Country:US
Practice Address - Phone:212-432-1110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00345-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist