Provider Demographics
NPI:1700294030
Name:PECK, ROBERT J (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:PECK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:160 1ST ST UNIT 41
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-5001
Mailing Address - Country:US
Mailing Address - Phone:516-587-9981
Mailing Address - Fax:
Practice Address - Street 1:190 1ST ST
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4011
Practice Address - Country:US
Practice Address - Phone:516-587-9981
Practice Address - Fax:516-548-0078
Is Sole Proprietor?:No
Enumeration Date:2014-07-30
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006945-1213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist