Provider Demographics
NPI:1477619716
Name:JERABECK, PETER EDWARD (OTR)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:EDWARD
Last Name:JERABECK
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 RALPH PLACE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304
Mailing Address - Country:US
Mailing Address - Phone:718-447-0733
Mailing Address - Fax:718-447-2423
Practice Address - Street 1:11 RALPH PLACE
Practice Address - Street 2:SUITE 111
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304
Practice Address - Country:US
Practice Address - Phone:718-447-0733
Practice Address - Fax:718-447-2423
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1705225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY160897OtherELDERPLAN
NY19868POtherHIP
NY4C2101OtherHEALTH NET
NYOS165OtherOXFORD
NY014290OtherGROUP HEALTH INC
NY160897OtherELDERPLAN