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Individual

PETER MA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
1825 EASTCHESTER RD, BRONX, NY 10461-2301
(718) 904-2400
Mailing address
658 STEWART AVE, STATEN ISLAND, NY 10314-4219
(646) 431-8186

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
016179
NY

Other

Enumeration date
11/01/2012
Last updated
11/01/2012
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