D T Peterson DPM PC

Primary specialty

Foot Surgery PodiatristTaxonomy code 213ES0131X

License

N004585 Issued in NY

Legal business name

D T PETERSON DPM PC

Practice address

8029 Jericho Tpke
Woodbury, NY 11797-1212

Phone

(516) 496-0900

Fax

(516) 496-0901

NPI assigned

Nov 19, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Donald Thorgeir Peterson, DPMNPI 1649206558

Title

Owner

Phone

(516) 496-0900

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Donald Thorgeir Peterson, DPM

  • Foot Surgery Podiatrist
  • Woodbury, NY
  • NPI 1649206558
  Medicare reassignment NPD Authorized official
• Owen James McCrudden, DPM

  • Foot Surgery Podiatrist
  • Woodbury, NY
  • NPI 1285641886
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1290124800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725148800000",
    "number": "1376845669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8029 JERICHO TPKE",
            "city": "WOODBURY",
            "state": "NY",
            "postal_code": "117971212",
            "telephone_number": "516-496-0900",
            "fax_number": "516-496-0901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8029 JERICHO TPKE",
            "city": "WOODBURY",
            "state": "NY",
            "postal_code": "117971212",
            "telephone_number": "516-496-0900",
            "fax_number": "516-496-0901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "D T PETERSON DPM PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-19",
        "last_updated": "2024-09-01",
        "certification_date": "2024-09-01",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "THORGEIR",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "516-496-0900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0131X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot Surgery",
            "state": "NY",
            "license": "N004585",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01349628-3",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cottage Pharmacy & Surgical Inc
• Cottage Pharmacy & Surgical, Inc
• Daniel Francis Coyle, DDS
• Crossways Medical PLLC
• Katherine Cruz, DPT
• D T Peterson DPM PC
• D.C. Audiology, P.C.
• Lianna Dambrosio, OTR/L
• Cheryl Elizabeth Daves, M.D.
• David a Schlessinger, M.D.,P.C.

• Foot Surgery Podiatrist in Woodbury, NY
• Providers in Woodbury, NY by specialty
• Foot Surgery Podiatrist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.