Provider Demographics
NPI:1154429736
Name:KAZANOVICZ, PETER J (BCO)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:J
Last Name:KAZANOVICZ
Suffix:
Gender:M
Credentials:BCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 S RIVER RD
Mailing Address - Street 2:SUITE 14A
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6971
Mailing Address - Country:US
Mailing Address - Phone:603-622-5200
Mailing Address - Fax:603-644-2354
Practice Address - Street 1:169 S RIVER RD
Practice Address - Street 2:SUITE 14A
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6971
Practice Address - Country:US
Practice Address - Phone:603-622-5200
Practice Address - Fax:603-644-2354
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH96-270-08225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA7501595Medicaid
NH0228590002Medicare ID - Type Unspecified
ME0228590004Medicare ID - Type Unspecified
MA7501595Medicaid