Provider Demographics
NPI:1982637898
Name:DZENIS, PETERIS E (MD)
Entity Type:Individual
Prefix:DR
First Name:PETERIS
Middle Name:E
Last Name:DZENIS
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 1:5510 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5050
Mailing Address - Country:US
Mailing Address - Phone:718-463-9220
Mailing Address - Fax:718-463-9214
Practice Address - Street 1:5510 MAIN ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5050
Practice Address - Country:US
Practice Address - Phone:718-463-9220
Practice Address - Fax:718-463-9214
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY154791-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA60885Medicare UPIN