Provider Demographics
NPI:1316595465
Name:KARKANTZELIS, PETER NICHOLAS (DPT)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:NICHOLAS
Last Name:KARKANTZELIS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 EDGEWATER RD
Mailing Address - Street 2:
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010-2922
Mailing Address - Country:US
Mailing Address - Phone:201-655-0312
Mailing Address - Fax:
Practice Address - Street 1:128 EDGEWATER RD
Practice Address - Street 2:
Practice Address - City:CLIFFSIDE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07010-2922
Practice Address - Country:US
Practice Address - Phone:201-655-0312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-03
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA24588225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist