Peter Joseph Avvento, M.D.
Individual provider Active NPI Internal Medicine Physician · Northport, NY
NPI 1356874499 · NPPES record last updated Dec 3, 2020
Key facts
- NPI
- 1356874499
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 306798 (NY)
- Practice address
- 79 Middleville Rd Dept of
Northport, NY 11768-2200 - Phone
- (631) 261-4400
- NPI assigned
- Apr 5, 2017
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190916000124 | NY | Order and Referring Only - Internal Medicine |
5698004737 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 306798 | NY | MD | Adult Health Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 306798 | NY | Yes |
Addresses
Primary practice location
79 Middleville Rd Dept of
Northport, NY 11768-2200
Mailing address
79 Middleville Rd Dept of
Northport, NY 11768-2200
Phone (631) 261-4400
Other practice location 1
100 Nicolls Rd
Dept of Medicine, HSC level 16 SUNY Stony Brook Hospita
Stony Brook, NY 11794-3157
Phone (908) 216-6284
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- Vanessa Marie Attard
- Murty Ayyala
- Marilyn Joseph Bacchus
- George Bach
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All providers in Northport, NY · Internal Medicine Physician in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 3, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.