Healthcare Provider Details

I. General information

NPI: 1154429736
Provider Name (Legal Business Name): PETER J KAZANOVICZ B.C.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 S RIVER RD SUITE 14A
BEDFORD NH
03110-6971
US

IV. Provider business mailing address

169 S RIVER RD SUITE 14A
BEDFORD NH
03110-6971
US

V. Phone/Fax

Practice location:
  • Phone: 603-622-5200
  • Fax: 603-644-2354
Mailing address:
  • Phone: 603-622-5200
  • Fax: 603-644-2354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number96-270-08
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: