Basic Information
| Provider Information | |||||||||
| NPI: | 1629074232 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PETERSON | ||||||||
| FirstName: | JILL | ||||||||
| MiddleName: | CHRISTINE | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 445 FACTORY ST | ||||||||
| Address2: | |||||||||
| City: | WATERTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 136012729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852234292 | ||||||||
| FaxNumber: | 8778341323 | ||||||||
| Practice Location | |||||||||
| Address1: | 622 WASHINGTON ST | ||||||||
| Address2: | COMPREHENSIVE WOMENS HEALTH SERVICES | ||||||||
| City: | WATERTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 136014036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157882003 | ||||||||
| FaxNumber: | 3157887087 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2005 | ||||||||
| LastUpdateDate: | 03/26/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 231343 | NY | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207P00000X | 231343 | NY | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.