Provider Demographics
NPI:1215114632
Name:KRAKOFF, PETER LOUIS (PHD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:LOUIS
Last Name:KRAKOFF
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 LAKE PARK DR
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-5124
Mailing Address - Country:US
Mailing Address - Phone:732-463-3768
Mailing Address - Fax:732-235-0589
Practice Address - Street 1:144 LIVINGSTON AVE
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-2936
Practice Address - Country:US
Practice Address - Phone:732-763-9255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100179000103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist