Provider Demographics
NPI:1699792382
Name:ILOWITE, PETER G (DO)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:G
Last Name:ILOWITE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 MARKET AVE
Mailing Address - Street 2:
Mailing Address - City:SADDLE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07663-6094
Mailing Address - Country:US
Mailing Address - Phone:201-843-7177
Mailing Address - Fax:201-556-0970
Practice Address - Street 1:275 MARKET AVE
Practice Address - Street 2:
Practice Address - City:SADDLE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07663-6094
Practice Address - Country:US
Practice Address - Phone:201-843-7177
Practice Address - Fax:201-556-0970
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB05670100207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0K0076OtherHEALTHNET
2200223OtherGHI
BS825OtherOXFORD
462303OtherAETNA
462303OtherAETNA
E96508Medicare UPIN