Active NPI
Jennifer Peterman
- Specialist
- Middletown, NY
National Provider Identifier
1205190758
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 522250111
- Practice address
- 2277 Goshen Tpke
Middletown, NY 10941-4032 - Phone
- (845) 692-4391
- NPI assigned
- Jun 29, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 522250111 | NY | Primary |
Addresses
Primary practice location
2277 Goshen Tpke
Middletown, NY 10941-4032
Mailing address
11 Elm St
Chester, NY 10918-1346
Phone (845) 781-6513
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 522250111 | NY | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1340928000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1340928000000",
"number": "1205190758",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11 ELM ST",
"city": "CHESTER",
"state": "NY",
"postal_code": "109181346",
"telephone_number": "845-781-6513"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2277 GOSHEN TPKE",
"city": "MIDDLETOWN",
"state": "NY",
"postal_code": "109414032",
"telephone_number": "845-692-4391"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERMAN",
"first_name": "JENNIFER",
"name_prefix": "Mrs.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-06-29",
"last_updated": "2012-06-29",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "NY",
"license": "522250111",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Middletown, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.