Healthcare Provider Details

I. General information

NPI: 1538492566
Provider Name (Legal Business Name): CHRISTINE J. PETERSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2009
Last Update Date: 04/12/2021
Certification Date: 04/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 E 70TH ST
NEW YORK NY
10021-4823
US

IV. Provider business mailing address

PO BOX 27578
NEW YORK NY
10087-7578
US

V. Phone/Fax

Practice location:
  • Phone: 212-606-1036
  • Fax: 212-517-4881
Mailing address:
  • Phone: 631-329-6925
  • Fax: 631-329-6951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number236799
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number236799
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: