MEDICARE: DR. ROBERT M PESKIN D.D.S.

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	1223G0001X	General Practice Dentistry	32715	NY
2	1223G0001X	General Practice Dentistry	7717	CO
3	1223D0004X	Dental Anesthesiology	000248	NY

General Provider Information

NPI Number	:	1720118375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT M PESKIN D.D.S.

Provider Business Mailing Address
First Line	:	601 FRANKLIN AVE
Second Line	:	SUITE 225
City	:	GARDEN CITY
State	:	NY
Zip	:	11530-5795
Country	:	US
Telephone Number	:	516-746-2434
Fax Number	:	516-746-3639

Provider Business Practice Location Address
First Line	:	601 FRANKLIN AVENUE
Second Line	:	SUITE 225
City	:	GARDEN CITY
State	:	NY
Zip	:	11530-5742
Country	:	US
Telephone Number	:	516-746-2434
Fax Number	:	516-746-3639

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

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	05/15/2014

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