Healthcare Provider Details

I. General information

NPI: 1134202716
Provider Name (Legal Business Name): PETER ST. GERMAIN P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 03/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4164 NY ROUTE 2
CROPSEYVILLE NY
12052
US

IV. Provider business mailing address

8 EMPIRE DR
POESTENKILL NY
12140-2104
US

V. Phone/Fax

Practice location:
  • Phone: 518-788-4567
  • Fax: 518-272-3911
Mailing address:
  • Phone: 518-788-4567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number017795
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: