Provider Demographics
NPI:1972628766
Name:PETERKA, ANN (DO)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:
Last Name:PETERKA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 NO HIGHCREST DR
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07506
Mailing Address - Country:US
Mailing Address - Phone:973-235-3178
Mailing Address - Fax:
Practice Address - Street 1:HOFFMANN LA ROCHE
Practice Address - Street 2:340 KINGSLAND STREET B-126T
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110
Practice Address - Country:US
Practice Address - Phone:973-235-3178
Practice Address - Fax:973-235-2117
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB52351207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine