1720160195 NPI number — DR. PARRY A PEET DC

Table of content: DR. PARRY A PEET DC (NPI 1720160195)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720160195 NPI number — DR. PARRY A PEET DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEET
Provider First Name:
PARRY
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720160195
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 SPRING SQUARE BUSINESS PARK
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWBURGH
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12550-2567
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-566-1313
Provider Business Mailing Address Fax Number:
845-566-1379

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 SPRING SQUARE BUSINESS PARK
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWBURGH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12550-2567
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-566-1313
Provider Business Practice Location Address Fax Number:
845-566-1379
Provider Enumeration Date:
10/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  C04107 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2003809 . This is a "AETNA PROVIDER ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 10089518 . This is a "CDCHP PROVIDER ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 911668 . This is a "ACN PROVIDER ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: PP105803 . This is a "ASH PROVIDER ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 815968 . This is a "MPN PROVIDER ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 98L910 . This is a "MVP PROVIDER ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6004746 . This is a "GHI PROVIDER ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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