Individual
DR. NILS W PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
200 MADISON AVE, ELMIRA, NY 14901-3218
(607) 734-1581
(607) 767-4137
Mailing address
722 W WATER ST, ELMIRA, NY 14905-2435
(607) 271-2093
(607) 271-2099
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
113052
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00358296
—
NY
Enumeration date
06/07/2006
Last updated
04/16/2014
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