Provider Demographics
NPI:1023238789
Name:LOBRUTTO, PETER CLIFFORD (DC CDN)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:CLIFFORD
Last Name:LOBRUTTO
Suffix:
Gender:M
Credentials:DC CDN
Other - Prefix:
Other - First Name:P
Other - Middle Name:CLIFFORD
Other - Last Name:LOBRUTTO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC CDN
Mailing Address - Street 1:27-51 27TH STREET
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102
Mailing Address - Country:US
Mailing Address - Phone:718-728-0612
Mailing Address - Fax:718-545-7771
Practice Address - Street 1:27-51 27TH STREET
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102
Practice Address - Country:US
Practice Address - Phone:718-728-0612
Practice Address - Fax:718-545-7771
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0029791111N00000X
NY0037561133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01751353Medicaid
T32088Medicare UPIN