Provider Demographics
NPI:1316132079
Name:CRAIN, PETER MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:MICHAEL
Last Name:CRAIN
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:ONE WEST RIDGEWOOD AVENUE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-2359
Mailing Address - Country:US
Mailing Address - Phone:201-444-9772
Mailing Address - Fax:201-444-4220
Practice Address - Street 1:ONE WEST RIDGEWOOD AVENUE
Practice Address - Street 2:SUITE 101
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2359
Practice Address - Country:US
Practice Address - Phone:201-444-9772
Practice Address - Fax:201-444-4220
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA037097002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
1C440652Medicare PIN