Provider Demographics
NPI:1235280132
Name:PELEG, MOTI (PHD, DSW)
Entity Type:Individual
Prefix:DR
First Name:MOTI
Middle Name:
Last Name:PELEG
Suffix:
Gender:M
Credentials:PHD, DSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 PINE ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-1619
Mailing Address - Country:US
Mailing Address - Phone:201-652-6843
Mailing Address - Fax:201-652-2187
Practice Address - Street 1:115 PINE ST
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-1619
Practice Address - Country:US
Practice Address - Phone:201-652-6843
Practice Address - Fax:201-652-2187
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100293100103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJBS492OtherOXFORD HEALTH PLANS
NJ31983316801070OtherGHI
NJ60054OtherAETNA
NJV9B473OtherNORTH SHORE NJ EMPIRE
NJ31983316801070OtherGHI
NJBS492OtherOXFORD HEALTH PLANS