Provider Demographics
NPI:1376758979
Name:KAPLAN, PETER ADAM (PHD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:ADAM
Last Name:KAPLAN
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 1:62 ROCKY HILL RD
Mailing Address - Street 2:
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-3120
Mailing Address - Country:US
Mailing Address - Phone:845-255-1440
Mailing Address - Fax:845-255-1440
Practice Address - Street 1:62 ROCKY HILL RD
Practice Address - Street 2:
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561-3120
Practice Address - Country:US
Practice Address - Phone:845-255-1440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011288103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02110130Medicaid
6887390OtherGHI
NYV6B171Medicare ID - Type Unspecified
NY680013988Medicare ID - Type UnspecifiedRR MEDICARE