Provider Demographics
NPI:1861415606
Name:SANFILIPPO, PETER SEBASTIAN (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:SEBASTIAN
Last Name:SANFILIPPO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22242
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11202-2242
Mailing Address - Country:US
Mailing Address - Phone:718-371-8299
Mailing Address - Fax:718-246-2252
Practice Address - Street 1:3710 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-3865
Practice Address - Country:US
Practice Address - Phone:718-371-8299
Practice Address - Fax:718-317-0888
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199699207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG62047Medicare UPIN