Healthcare Provider Details

I. General information

NPI: 1669453296
Provider Name (Legal Business Name): PETER STEENBERGEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 03/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 ENTERPRISE DR STE 220
SHELTON CT
06484-4694
US

IV. Provider business mailing address

3 ENTERPRISE DR STE 220
SHELTON CT
06484-4694
US

V. Phone/Fax

Practice location:
  • Phone: 203-696-6125
  • Fax: 203-696-6130
Mailing address:
  • Phone: 203-696-6125
  • Fax: 203-696-6130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number025333
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: