Healthcare Provider Details

I. General information

NPI: 1003070558
Provider Name (Legal Business Name): PETER URAZOV DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2008
Last Update Date: 03/24/2023
Certification Date: 03/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HOSPITAL RD SUITE 203
EAST PATCHOGUE NY
11772-8809
US

IV. Provider business mailing address

100 HOSPITAL RD SUITE 203
EAST PATCHOGUE NY
11772-8809
US

V. Phone/Fax

Practice location:
  • Phone: 631-475-6900
  • Fax: 631-447-5954
Mailing address:
  • Phone: 631-475-6900
  • Fax: 631-447-5954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number253737
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: