Provider Demographics
NPI:1316064173
Name:BETZIOS, PETER (DPM)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:BETZIOS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 UNION ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-1750
Mailing Address - Country:US
Mailing Address - Phone:718-762-4700
Mailing Address - Fax:
Practice Address - Street 1:2801 UNION ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-1750
Practice Address - Country:US
Practice Address - Phone:718-762-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005173213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP594420OtherOXFORD
NMP5213OtherBLUE CROSS BLUE SHIELD
NY6201191OtherGHI
NY6201191OtherGHI
NMP5213OtherBLUE CROSS BLUE SHIELD