Provider Demographics
NPI:1023450343
Name:PETERS, ANNE MARIE (NPP)
Entity type:Individual
Prefix:PROF
First Name:ANNE MARIE
Middle Name:
Last Name:PETERS
Suffix:
Gender:F
Credentials:NPP
Other - Prefix:MRS
Other - First Name:ANNE MARIE
Other - Middle Name:
Other - Last Name:BOGOSIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NPP
Mailing Address - Street 1:178 AUDUBON BLVD
Mailing Address - Street 2:
Mailing Address - City:ISLAND PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11558-1707
Mailing Address - Country:US
Mailing Address - Phone:917-531-4953
Mailing Address - Fax:
Practice Address - Street 1:178 AUDUBON BLVD
Practice Address - Street 2:
Practice Address - City:ISLAND PARK
Practice Address - State:NY
Practice Address - Zip Code:11558-1707
Practice Address - Country:US
Practice Address - Phone:917-531-4953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-29
Last Update Date:2025-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY515863163W00000X
NYF401651363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse