Provider Demographics
NPI:1013064914
Name:BOHLMAN, PETER ANDREW JR (PA)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:ANDREW
Last Name:BOHLMAN
Suffix:JR
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-7709
Mailing Address - Country:US
Mailing Address - Phone:718-463-5497
Mailing Address - Fax:
Practice Address - Street 1:329 LOCUST ST
Practice Address - Street 2:
Practice Address - City:SOUTH HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-7709
Practice Address - Country:US
Practice Address - Phone:718-463-5497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005974363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant