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General NPI Number Information
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NPI Number | 1134202716
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Entity Type | Individual
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Provider Name | PETER ST. GERMAIN P.T.
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Gender | Male
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 03/04/2009
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Provider Practice Location Address
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Address Line | 4164 NY ROUTE 2
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City | CROPSEYVILLE
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State | NY
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Zip | 12052
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Country | US
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Telephone | 518-788-4567
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Fax | 518-272-3911
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Provider Business Mailing Address
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Address Line | 8 EMPIRE DR
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City | POESTENKILL
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State | NY
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Zip | 12140-2104
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Country | US
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Telephone | 518-788-4567
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 017795
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License Number State | NY
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