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General NPI Number Information
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NPI Number | 1457542862
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Entity Type | Individual
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Provider Name | PETER R. BREGGIN MD
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Gender | Male
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Dates
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Enumeration Date | 08/09/2007
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Last Update Date | 08/09/2007
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Provider Practice Location Address
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Address Line | 313 N TIOGA ST FIRST FLOOR
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City | ITHACA
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State | NY
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Zip | 14850-4205
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Country | US
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Telephone | 607-272-5328
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Fax |
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Provider Business Mailing Address
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Address Line | 101 E STATE ST NO. 112
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City | ITHACA
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State | NY
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Zip | 14850-5543
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Country | US
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Telephone |
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 093436-1
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License Number State | NY
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