Provider Demographics
NPI:1952760282
Name:PETER J HEALY DDS
Entity Type:Organization
Organization Name:PETER J HEALY DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:HEALY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-892-7114
Mailing Address - Street 1:1725 EDISON AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-4850
Mailing Address - Country:US
Mailing Address - Phone:718-892-7114
Mailing Address - Fax:718-892-7494
Practice Address - Street 1:1725 EDISON AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-4850
Practice Address - Country:US
Practice Address - Phone:718-892-7114
Practice Address - Fax:718-892-7494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037644-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty