Provider Demographics
NPI:1245328137
Name:SCHULTZ, PETER (MSPT)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:SCHULTZ
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 E 39TH ST
Mailing Address - Street 2:SUITE 504
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-0112
Mailing Address - Country:US
Mailing Address - Phone:212-317-8303
Mailing Address - Fax:212-317-8258
Practice Address - Street 1:6 E 39TH ST
Practice Address - Street 2:SUITE 504
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-0112
Practice Address - Country:US
Practice Address - Phone:212-317-8303
Practice Address - Fax:212-317-8258
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020808225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ34Z41OtherBLUE CROSS BLUE SHIELD
NY1194993519OtherGROUP NPI
NY42-1690083OtherTAX ID NUMBER
NYA400039114Medicare PIN