Healthcare Provider Details

I. General information

NPI: 1255741435
Provider Name (Legal Business Name): PETER LAWRENCE SUNARYO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2014
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 E 98TH ST FL 5
NEW YORK NY
10029-6501
US

IV. Provider business mailing address

150 E 42ND ST FL 5
NEW YORK NY
10017-5612
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-4812
  • Fax:
Mailing address:
  • Phone: 646-605-8119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number344581
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: