Provider Demographics
NPI:1386876829
Name:SANSONE, PETER JOHN (DC)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:JOHN
Last Name:SANSONE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 1ST ST
Mailing Address - Street 2:# 4G
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-1902
Mailing Address - Country:US
Mailing Address - Phone:718-499-6299
Mailing Address - Fax:718-499-6399
Practice Address - Street 1:264 1ST ST
Practice Address - Street 2:# 4G
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-1902
Practice Address - Country:US
Practice Address - Phone:718-499-6299
Practice Address - Fax:718-499-6399
Is Sole Proprietor?:No
Enumeration Date:2009-08-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007439111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation