Provider Demographics
NPI:1811973258
Name:SIMONSON, PETER T (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:T
Last Name:SIMONSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:257 LAFAYETTE AVENUE
Mailing Address - Street 2:SUITE 120 SUFFERN MEDICAL PAVILION
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901
Mailing Address - Country:US
Mailing Address - Phone:845-369-9100
Mailing Address - Fax:845-369-6738
Practice Address - Street 1:257 LAFAYETTE AVENUE
Practice Address - Street 2:SUITE 120 SUFFERN MEDICAL PAVILION
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901
Practice Address - Country:US
Practice Address - Phone:845-369-9100
Practice Address - Fax:845-369-6738
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2012-02-24
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Provider Licenses
StateLicense IDTaxonomies
NY176473207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY90F321Medicare ID - Type Unspecified
E86369Medicare UPIN