Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 051908 | NY |
NPI | 1013115765 |
---|---|
Provider Name | Dr. Peter Feibish |
First Address | Sparta, NJ 07871-3003 |
Second Address | Brooklyn, NY 11223-3554 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2007 |
Last Update Date | 08/07/2007 |