Provider Demographics
NPI:1669976601
Name:ROSSI, PETER JUSTIN (MD, PHD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:JUSTIN
Last Name:ROSSI
Suffix:
Gender:
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 E 63RD ST APT 7N
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-7939
Mailing Address - Country:US
Mailing Address - Phone:917-763-3400
Mailing Address - Fax:
Practice Address - Street 1:14153 YOSEMITE DR
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-8060
Practice Address - Country:US
Practice Address - Phone:917-763-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-23
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3132882084P0800X
FL1615862084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry