Individual
MICHAEL JAMES PETERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4 TECHNOLOGY DR, SUITE 120, EAST SETAUKET, NY 11733-4068
(631) 246-8289
(631) 246-8294
Mailing address
4 TECHNOLOGY DR, SUITE 120, EAST SETAUKET, NY 11733-4068
(631) 246-8289
(631) 246-8294
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
175936
NY
2086S0129X
Vascular Surgery Physician
Primary
175936
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0714028004
CIGNA HEALTHCARE
NY
01
—
11347567803
1199 BENEFIT FUND
NY
01
—
1261940
UNITED HEALTHCARE
NY
01
—
2110430
AETNA HEALTH PLANS
NM
01
—
2C4298
HEALTHNET
NY
01
—
990015026
RR MEDICARE
NY
01
—
CS1072
OXFORD HEALTH PLANS
NY
01
—
GHI PPO CBP
0103702
NM
01
—
S500051
SUFFOLK HEALTH PLANS
NY
Enumeration date
08/24/2005
Last updated
06/06/2016
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