Provider Demographics
NPI:1700802980
Name:PROTZEL, PETER EVAN (DDS, MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:EVAN
Last Name:PROTZEL
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4277 HEMPSTEAD TURNPIKE
Mailing Address - Street 2:SUITE 214
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714
Mailing Address - Country:US
Mailing Address - Phone:516-735-6505
Mailing Address - Fax:516-735-3326
Practice Address - Street 1:4277 HEMPSTEAD TPKE
Practice Address - Street 2:SUITE 214
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-5709
Practice Address - Country:US
Practice Address - Phone:516-735-6505
Practice Address - Fax:516-735-3326
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047168204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02339499Medicaid
NY02339499Medicaid
NYH83765Medicare UPIN