Healthcare Provider Details

I. General information

NPI: 1184203788
Provider Name (Legal Business Name): PETER HAMILTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2021
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 E MAIN ST
PORT JERVIS NY
12771-2114
US

IV. Provider business mailing address

160 E MAIN ST
PORT JERVIS NY
12771-2114
US

V. Phone/Fax

Practice location:
  • Phone: 845-858-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number341825
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: