Provider Demographics
NPI:1912112111
Name:PETER A. D'ARIENZO, M.D.
Entity Type:Organization
Organization Name:PETER A. D'ARIENZO, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:D'ARIENZO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-349-2020
Mailing Address - Street 1:411 GRAHAM AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-2421
Mailing Address - Country:US
Mailing Address - Phone:718-349-2020
Mailing Address - Fax:718-383-6717
Practice Address - Street 1:411 GRAHAM AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-2421
Practice Address - Country:US
Practice Address - Phone:718-349-2020
Practice Address - Fax:718-383-6717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY187507-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY86T922Medicare PIN