Provider Demographics
NPI:1770748709
Name:BROER, PETER NICLAS
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:NICLAS
Last Name:BROER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 MANSFIELD GROVE RD
Mailing Address - Street 2:
Mailing Address - City:EAST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06512-4804
Mailing Address - Country:US
Mailing Address - Phone:203-606-5373
Mailing Address - Fax:
Practice Address - Street 1:20 YORK STREET, T-209
Practice Address - Street 2:YALE NEW HAVEN HOSPITAL
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510
Practice Address - Country:US
Practice Address - Phone:203-668-2259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program