Provider Demographics
NPI:1356579981
Name:RUMACK, PETER M (DDS)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:M
Last Name:RUMACK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14116 JEWEL AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-1618
Mailing Address - Country:US
Mailing Address - Phone:718-268-2552
Mailing Address - Fax:718-268-3828
Practice Address - Street 1:14116 JEWEL AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-1618
Practice Address - Country:US
Practice Address - Phone:718-268-2552
Practice Address - Fax:718-268-3828
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0337351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice