Provider Demographics
NPI:1194719039
Name:SENATORE, PETER JOSEPH JR (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:JOSEPH
Last Name:SENATORE
Suffix:JR
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 1:1102 E CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-5002
Mailing Address - Country:US
Mailing Address - Phone:856-213-6375
Mailing Address - Fax:856-213-6458
Practice Address - Street 1:1505 W SHERMAN AVE STE B
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-7059
Practice Address - Country:US
Practice Address - Phone:856-641-8635
Practice Address - Fax:856-641-8636
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09377100208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3035271Medicaid
34713OtherFALLON
J07433OtherBCBS
A59328Medicare UPIN
J07433Medicare ID - Type Unspecified