Provider Demographics
NPI:1982761607
Name:HEALY, PETER J (DDS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:J
Last Name:HEALY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 EDISON AVE
Mailing Address - Street 2:LOBBY C
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:LOBBY C
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
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037644-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice