Provider Demographics
NPI:1770783011
Name:PETER Y SIROKA DPM PC
Entity type:Organization
Organization Name:PETER Y SIROKA DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM PC
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:Y
Authorized Official - Last Name:SIROKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-614-8185
Mailing Address - Street 1:1450 WASHINGTON BLVD
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-2451
Mailing Address - Country:US
Mailing Address - Phone:203-327-9321
Mailing Address - Fax:203-967-2140
Practice Address - Street 1:1275 SUMMER ST STE 106
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5315
Practice Address - Country:US
Practice Address - Phone:203-614-8185
Practice Address - Fax:203-614-8186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003988-1213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT56030000334CT1OtherANTHEM BCBS
CT5322640002Medicare NSC
CT56030000334CT1OtherANTHEM BCBS
NY17920Medicare UPIN
CT56030000334CT1OtherANTHEM BCBS
NY5322640001Medicare NSC
CT5322640002Medicare NSC