Provider Demographics
NPI:1154415461
Name:KO, PETER Y (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:Y
Last Name:KO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14307 SANFORD AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-2046
Mailing Address - Country:US
Mailing Address - Phone:718-539-5400
Mailing Address - Fax:718-539-5190
Practice Address - Street 1:14307 SANFORD AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-2046
Practice Address - Country:US
Practice Address - Phone:718-539-5400
Practice Address - Fax:718-539-5190
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY118242207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine