Healthcare Provider Details

I. General information

NPI: 1609809722
Provider Name (Legal Business Name): PETER CHARLES WYER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date: 07/19/2006
Reactivation Date: 11/16/2006

III. Provider practice location address

COLUMBIA UNIVERSITY MED CENTER 622 W 168 STREET PH 1-137
NEW YORK NY
10032-3784
US

IV. Provider business mailing address

ASSOCIATES W EMERGENCY SERVICES/CLINIC 622 W 168 STREET PH 1-137
NEW YORK NY
10032-3784
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-2995
  • Fax: 212-305-6792
Mailing address:
  • Phone: 212-305-2995
  • Fax: 212-305-6792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number125363
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: