Provider Demographics
NPI:1124042759
Name:KRAUS, RON (PHD)
Entity Type:Individual
Prefix:DR
First Name:RON
Middle Name:
Last Name:KRAUS
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 1:1398 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666
Mailing Address - Country:US
Mailing Address - Phone:201-692-0857
Mailing Address - Fax:201-692-8507
Practice Address - Street 1:333 W 57TH ST #103
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:NY
Practice Address - Zip Code:10019
Practice Address - Country:US
Practice Address - Phone:877-375-7287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY12706103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01742227Medicaid
NY01742227Medicaid