Provider Demographics
NPI:1164686325
Name:KRAKER, JENNIFER LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNN
Last Name:KRAKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:286 MADISON AVE
Mailing Address - Street 2:PENTHOUSE STE.
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-6345
Mailing Address - Country:US
Mailing Address - Phone:212-213-9286
Mailing Address - Fax:
Practice Address - Street 1:286 MADISON AVE
Practice Address - Street 2:PENTHOUSE STE.
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-6345
Practice Address - Country:US
Practice Address - Phone:212-213-9286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2577412084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry