Provider Demographics
NPI:1316042682
Name:ARENA, PETER P JR
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:P
Last Name:ARENA
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6131 LAKE WORTH RD
Mailing Address - Street 2:#C
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-3074
Mailing Address - Country:US
Mailing Address - Phone:561-964-8627
Mailing Address - Fax:561-964-1091
Practice Address - Street 1:6131 LAKE WORTH RD
Practice Address - Street 2:#C
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-3074
Practice Address - Country:US
Practice Address - Phone:561-964-8627
Practice Address - Fax:561-964-1091
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PED37174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1124700001Medicare NSC