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General NPI Number Information
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NPI Number | 1760652390
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Entity Type | Individual
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Provider Name | BRIAN A PETERKIN PA-C
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Gender | Male
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Dates
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Enumeration Date | 03/11/2008
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Last Update Date | 03/11/2008
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Provider Practice Location Address
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Address Line | 33 OVERLOOK RD SUITE 305
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City | SUMMIT
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State | NJ
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Zip | 07901-3570
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Country | US
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Telephone | 908-608-9610
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Fax | 973-233-9688
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Provider Business Mailing Address
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Address Line | 33 OVERLOOK RD SUITE 305
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City | SUMMIT
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State | NJ
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Zip | 07901-3570
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Country | US
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Telephone | 908-608-9610
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Fax | 973-233-9688
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 25MP00194900
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License Number State | NJ
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