Provider Demographics
NPI:1104253772
Name:PEDERSON-KRAG
Entity type:Organization
Organization Name:PEDERSON-KRAG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:TONER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-301-8289
Mailing Address - Street 1:77 RADCLIFFE AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-5222
Mailing Address - Country:US
Mailing Address - Phone:516-301-8283
Mailing Address - Fax:
Practice Address - Street 1:77 RADCLIFFE AVE.
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735
Practice Address - Country:US
Practice Address - Phone:516-301-8283
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit