Provider Demographics
NPI:1134202716
Name:ST. GERMAIN, PETER (PT)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:ST. GERMAIN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 EMPIRE DR
Mailing Address - Street 2:
Mailing Address - City:POESTENKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12140-2104
Mailing Address - Country:US
Mailing Address - Phone:518-788-4567
Mailing Address - Fax:
Practice Address - Street 1:4164 NY ROUTE 2
Practice Address - Street 2:
Practice Address - City:CROPSEYVILLE
Practice Address - State:NY
Practice Address - Zip Code:12052
Practice Address - Country:US
Practice Address - Phone:518-788-4567
Practice Address - Fax:518-272-3911
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017795208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation