Provider Demographics
NPI:1932463668
Name:PETEREC, DEBORAH J
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:J
Last Name:PETEREC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 AVOCA AVE
Mailing Address - Street 2:
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-4705
Mailing Address - Country:US
Mailing Address - Phone:516-822-8026
Mailing Address - Fax:516-822-8026
Practice Address - Street 1:3901 AVOCA AVE
Practice Address - Street 2:
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-4705
Practice Address - Country:US
Practice Address - Phone:516-822-8026
Practice Address - Fax:516-822-8026
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1771493174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist