Provider Demographics
NPI:1336177823
Name:RIENZI, PETER ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:ANTHONY
Last Name:RIENZI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 TROY SCHENECTADY RD STE 203
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2461
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:2546 BALLTOWN RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12309-1079
Practice Address - Country:US
Practice Address - Phone:518-374-1444
Practice Address - Fax:518-374-0491
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY154946207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01173422Medicaid
NY10001715OtherCDPHP
NY11171OtherMVP
NY28N001OtherEMPIRE BC
NY5274651OtherAETNA
NY051115000051OtherFIDELIS
NY200149OtherSENIOR WHOLE HEALTH
NY000401258002OtherBSNENY
NY47352OtherGHI/HMO
NY56823UMedicare ID - Type UnspecifiedUPSTATE MEDICARE
NY000401258002OtherBSNENY