Healthcare Provider Details

I. General information

NPI: 1225422470
Provider Name (Legal Business Name): ALEXANDER W PETERS MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2015
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3355 BAINBRIDGE AVENUE DIVISION OF PEDIATRIC SURGERY
NEW YORK NY
10467
US

IV. Provider business mailing address

3355 BAINBRIDGE AVENUE DIVISION OF PEDIATRIC SURGERY
BRONX NY
10467
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-7200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number143453
License Number StateMT
# 3
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number332430-01
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number76648-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: