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Individual

DR. PEGGY AW

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
M.D..

Contact information

Practice address
104 BERRY AVE, STATEN ISLAND, NY 10312-1510
(718) 984-0318
Mailing address
104 BERRY AVE, STATEN ISLAND, NY 10312-1510
(718) 984-0318

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
126834
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
126834
NYC PHYSICIAN LICENSE NUMBER
NY
Enumeration date
09/18/2009
Last updated
09/18/2009
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