Healthcare Provider Details

I. General information

NPI: 1861415606
Provider Name (Legal Business Name): PETER SEBASTIAN SANFILIPPO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3710 RICHMOND AVE
STATEN ISLAND NY
10312-3865
US

IV. Provider business mailing address

PO BOX 22242
BROOKLYN NY
11202-2242
US

V. Phone/Fax

Practice location:
  • Phone: 718-371-8299
  • Fax: 718-317-0888
Mailing address:
  • Phone: 718-371-8299
  • Fax: 718-246-2252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number199699
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: