Provider Demographics
NPI:1134100399
Name:PETERS, ERIC (DPM PC)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:PETERS
Suffix:
Gender:M
Credentials:DPM PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 E POST RD
Mailing Address - Street 2:STE 210-211
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601
Mailing Address - Country:US
Mailing Address - Phone:914-285-4444
Mailing Address - Fax:914-285-4495
Practice Address - Street 1:222 MAMARONECK AVE STE 310
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-1316
Practice Address - Country:US
Practice Address - Phone:845-536-8826
Practice Address - Fax:914-828-0270
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003112213E00000X
NJ25MD00200900213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00501726Medicaid
NY00501726Medicaid
T50976Medicare UPIN