Provider Demographics
NPI:1407923287
Name:PREKOPA, PEGGY ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:PEGGY
Middle Name:ANN
Last Name:PREKOPA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 STONETOWN RD
Mailing Address - Street 2:
Mailing Address - City:RINGWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07456-1229
Mailing Address - Country:US
Mailing Address - Phone:973-768-0513
Mailing Address - Fax:
Practice Address - Street 1:1069 RINGWOOD AVE STE 301-10
Practice Address - Street 2:
Practice Address - City:HASKELL
Practice Address - State:NJ
Practice Address - Zip Code:07420-1408
Practice Address - Country:US
Practice Address - Phone:973-768-0513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSIO3576103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7656807Medicaid
NJ034919Medicare ID - Type UnspecifiedPROVIDER ID NUMBER