Active NPI
Peter Statue, PHTC
- Technician/Technologist
- Sewell, NJ
National Provider Identifier
1942891072
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Technician/Technologist
- License
- 28RW00820400
- Practice address
- 500 Egg Harbor Rd
Sewell, NJ 08080-2336 - Phone
- (856) 256-7812
- NPI assigned
- Feb 1, 2021
- Last updated
- Feb 1, 2021
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Technician/Technologist | 156F00000X | 28RW00820400 | NJ | Primary |
Addresses
Primary practice location
500 Egg Harbor Rd
Sewell, NJ 08080-2336
Mailing address
340 Christina LN
Williamstown, NJ 08094-3600
Phone (856) 889-8670
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 |
|---|---|---|---|
| 28RW00820400 | NJ | MD | Technician/Technologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Current | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Locations
500 Egg Harbor Rd
Sewell, NJ 08080
Phone (856) 256-7812
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1612137600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1612137600000",
"number": "1942891072",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "340 CHRISTINA LN",
"city": "WILLIAMSTOWN",
"state": "NJ",
"postal_code": "080943600",
"telephone_number": "856-889-8670"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 EGG HARBOR RD",
"city": "SEWELL",
"state": "NJ",
"postal_code": "080802336",
"telephone_number": "856-256-7812"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STATUE",
"first_name": "PETER",
"credential": "PHTC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-02-01",
"last_updated": "2021-02-01",
"certification_date": "2021-02-01",
"status": "A"
},
"taxonomies": [
{
"code": "156F00000X",
"taxonomy_group": "",
"desc": "Technician/Technologist",
"state": "NJ",
"license": "28RW00820400",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sewell, NJ
- Mary Jeanne Spinosi, DO
- Lauren Elizabeth Spivack, M.D.
- Jordan Spusta, DO
- Rashmi Srivastava, DDS
- Steven Starr
- STC Pediatrics LLC (St. Christopher's Pediatric Associates Otolaryngology - Sewell)
- STC Pediatrics LLC (St. Christopher's Pediatric Associates Optometry - Sewell)
- STC Pediatrics LLC (St. Christopher's Pediatric Associates Plastic Surgery - Sewell)
- STC Pediatrics LLC (St. Christopher's Pediatric Associates General Surgery - Sewell)
- STC Pediatrics LLC (St. Christopher's Pediatric Associates Pulmonary - Sewell)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.