Provider Demographics
NPI:1497891402
Name:PETERS, GEORGE A (EDD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:A
Last Name:PETERS
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1747 HOOPER AVE
Mailing Address - Street 2:SUITE 16
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-8165
Mailing Address - Country:US
Mailing Address - Phone:732-255-3030
Mailing Address - Fax:732-255-5065
Practice Address - Street 1:1747 HOOPER AVE
Practice Address - Street 2:SUITE 16
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-8165
Practice Address - Country:US
Practice Address - Phone:732-255-3030
Practice Address - Fax:732-255-5065
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100145300103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ192648Medicare ID - Type Unspecified