Healthcare Provider Details

I. General information

NPI: 1154538346
Provider Name (Legal Business Name): PENINSULA HOSPITAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5115 BEACH CHANNEL DR
FAR ROCKAWAY NY
11691-1042
US

IV. Provider business mailing address

100 W 93RD ST. APT. 16C
NEW YORK NY
10025
US

V. Phone/Fax

Practice location:
  • Phone: 718-743-2000
  • Fax:
Mailing address:
  • Phone: 212-864-0970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: GERALD TEPLITZ
Title or Position: DERECTOR OF MEDICAL EDUCATION
Credential: D.O.
Phone: 718-734-3020