Provider Demographics
NPI:1811249873
Name:HART, PETER WILLIAM (AUD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:WILLIAM
Last Name:HART
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:468 TITUS AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-3541
Mailing Address - Country:US
Mailing Address - Phone:585-266-4130
Mailing Address - Fax:585-266-4532
Practice Address - Street 1:468 TITUS AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14617-3541
Practice Address - Country:US
Practice Address - Phone:585-266-4130
Practice Address - Fax:585-266-4532
Is Sole Proprietor?:No
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00002436-1231H00000X
NY14000036042237600000X, 237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY161163165OtherTAX ID