Provider Demographics
NPI:1699734921
Name:NNAEMEKA, PETER E (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:E
Last Name:NNAEMEKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 LOCKWOOD AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-4915
Mailing Address - Country:US
Mailing Address - Phone:914-235-1535
Mailing Address - Fax:914-235-0584
Practice Address - Street 1:140 LOCKWOOD AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-4915
Practice Address - Country:US
Practice Address - Phone:914-235-1535
Practice Address - Fax:914-235-0584
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY145021208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01008873Medicaid
NY01008873Medicaid
NY91D431Medicare PIN