Provider Demographics
NPI:1699954396
Name:PEETS, ROBERTA LYNN (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERTA
Middle Name:LYNN
Last Name:PEETS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:ROBERTA
Other - Middle Name:LYNN
Other - Last Name:FIORDALISI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:77A RT 25A
Mailing Address - Street 2:
Mailing Address - City:ROCKY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11778-8881
Mailing Address - Country:US
Mailing Address - Phone:631-849-6363
Mailing Address - Fax:
Practice Address - Street 1:100 W SUFFOLK AVE UNIT G
Practice Address - Street 2:
Practice Address - City:CENTRAL ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11722-2155
Practice Address - Country:US
Practice Address - Phone:631-993-5400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-30
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009368111N00000X
NY009368111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1538586177OtherGROUP NPI
1033976147OtherGROUP NPI
NY1518148089OtherGROUP NPI
NY1538586177OtherGROUP NPI