Individual
JESSICA PETERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2200 NORTHERN BLVD STE 104, GREENVALE, NY 11548-1220
(516) 304-7365
Mailing address
2200 NORTHERN BLVD STE 104, GREENVALE, NY 11548-1220
Taxonomy
Speciality
Code
Description
License number
State
207ZP0101X
Anatomic Pathology Physician
Primary
305820
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/10/2015
Last updated
11/09/2020
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