Healthcare Provider Details

I. General information

NPI: 1740549534
Provider Name (Legal Business Name): PEGGY WURM D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2012
Last Update Date: 05/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E 33RD ST SUITE 28J
NEW YORK NY
10016-4874
US

IV. Provider business mailing address

200 E 33RD ST SUITE 28J
NEW YORK NY
10016-4874
US

V. Phone/Fax

Practice location:
  • Phone: 646-522-4347
  • Fax: 212-679-3039
Mailing address:
  • Phone: 646-522-4347
  • Fax: 212-679-3039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number034033
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: