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General NPI Number Information
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NPI Number | 1356480495
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Entity Type | Individual
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Provider Name | PETER Q DYNER D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 11/22/2010
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Provider Practice Location Address
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Address Line | 273 HAMPTON RD
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City | SOUTHAMPTON
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State | NY
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Zip | 11968-5027
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Country | US
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Telephone | 631-283-1123
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Fax | 631-283-2766
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Provider Business Mailing Address
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Address Line | 273 HAMPTON RD
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City | SOUTHAMPTON
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State | NY
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Zip | 11968-5027
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Country | US
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Telephone | 631-283-1123
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Fax | 631-283-2766
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | N003833-1
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License Number State | NY
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