MEDICARE: DR. PETER J DUFFY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	231203	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00312164	OTHER	NY	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1376535385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER J DUFFY MD

Provider Business Mailing Address
First Line	:	1375 WASHINGTON AVE
Second Line	:	SUITE 227
City	:	ALBANY
State	:	NY
Zip	:	12206-1070
Country	:	US
Telephone Number	:	518-465-7172
Fax Number	:	518-465-7177

Provider Business Practice Location Address
First Line	:	1375 WASHINGTON AVE
Second Line	:	SUITE 227
City	:	ALBANY
State	:	NY
Zip	:	12206-1070
Country	:	US
Telephone Number	:	518-465-7172
Fax Number	:	518-465-7177

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	12/12/2007

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