Healthcare Provider Details

I. General information

NPI: 1487310314
Provider Name (Legal Business Name): DANA PETERS APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2021
Last Update Date: 08/21/2022
Certification Date: 08/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 W KENNEDY BLVD
LAKEWOOD NJ
08701-1224
US

IV. Provider business mailing address

590 W KENNEDY BLVD
LAKEWOOD NJ
08701-1224
US

V. Phone/Fax

Practice location:
  • Phone: 732-370-1111
  • Fax:
Mailing address:
  • Phone: 732-370-1111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number26NJ01229700
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number26NJ01229700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: