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General NPI Number Information
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NPI Number | 1043548183
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Entity Type | Organization
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Legal Business Name | PETER DISTLER, MD, PLLC
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Dates
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Enumeration Date | 12/01/2009
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Last Update Date | 12/01/2009
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Provider Practice Location Address
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Address Line | 3 EAST 83RD STREET
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City | NEW YORK
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State | NY
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Zip | 10028
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Country | US
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Telephone | 212-734-3444
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Fax | 212-734-3444
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Provider Business Mailing Address
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Address Line | P.O. BOX 1434
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City | SCARSDALE
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State | NY
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Zip | 10583-9434
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Country | US
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Telephone | 212-734-3444
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Fax | 212-734-0370
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Authorized Official
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Title or Position | OWNER
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Name | DR. PETER M. DISTLER
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Credential | M.D.
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Telephone | 212-734-3444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 179238
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License Number State | NY
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