Provider Demographics
NPI:1144347261
Name:SIEFKEN, PETER J (PA)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:J
Last Name:SIEFKEN
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:57 HAMPTON ROAD
Mailing Address - Street 2:STE 201
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11968
Mailing Address - Country:US
Mailing Address - Phone:631-283-1126
Mailing Address - Fax:631-283-7496
Practice Address - Street 1:518 MONTAUK HWY
Practice Address - Street 2:STE 102
Practice Address - City:AMAGANSETT
Practice Address - State:NY
Practice Address - Zip Code:11930
Practice Address - Country:US
Practice Address - Phone:631-267-5373
Practice Address - Fax:631-267-5376
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2016-12-05
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Provider Licenses
StateLicense IDTaxonomies
NY005732363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02175175Medicaid
NY4F771Medicare ID - Type Unspecified
NYP30664Medicare UPIN