| Doctor Name: | MR. PETER BRINK |
| NPI Number: | 1528339827 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | R.N |
| License Number: | 575633 |
| Business Practice Address: | 803 Grant Ave Lake Katrine, NY - 12449 |
| Business Phone Number: | 8453313970 |
| Business Fax Number: | |
| Mailing Address: | 4 Kingston St, KINGSTON |
| State: | NY |
| Postal Code: | 124012306 |
| Phone Number: | 8458533971 |
| Fax Number: | |
| NPI Enumeration Date: | 01/18/2012 |
| NPI Last Update Date: | 01/18/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WP0809X |
| License Number: | 575633 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Psych/Mental Health, Adult |
| Taxonomy Definition: | |