Provider Demographics
NPI:1871567560
Name:MYNN, PETER AUNG (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:AUNG
Last Name:MYNN
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 1:10 OLD JACKSON AVE
Mailing Address - Street 2:UNIT - 86
Mailing Address - City:HASTINGS ON HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:10706-3203
Mailing Address - Country:US
Mailing Address - Phone:914-478-0272
Mailing Address - Fax:
Practice Address - Street 1:300 COMMUNITY DRIVE
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030
Practice Address - Country:US
Practice Address - Phone:516-562-2308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD417706174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY202291Medicaid
PA001868936Medicaid
202291Medicare PIN
PAH07271Medicare UPIN
NY202291Medicaid
PA001868936Medicaid