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General NPI Number Information
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NPI Number | 1750544771
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Entity Type | Organization
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Legal Business Name | KENNETH H PETERSEL MD PC
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Dates
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Enumeration Date | 07/09/2008
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Last Update Date | 07/09/2008
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Provider Practice Location Address
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Address Line | 1617 FRONT ST
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City | EAST MEADOW
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State | NY
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Zip | 11554-2345
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Country | US
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Telephone | 516-794-1330
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Fax |
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Provider Business Mailing Address
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Address Line | 1617 FRONT ST
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City | EAST MEADOW
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State | NY
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Zip | 11554-2345
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Country | US
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Telephone | 516-794-1330
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | LOIS PETERSEL
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Credential |
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Telephone | 516-794-1330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 137623
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License Number State | NY
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