Provider Demographics
NPI:1518020189
Name:KLUGMAN, PETER J (PHD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:J
Last Name:KLUGMAN
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:PO BOX 1551
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-6551
Mailing Address - Country:US
Mailing Address - Phone:609-654-8640
Mailing Address - Fax:
Practice Address - Street 1:560 STOKES RD
Practice Address - Street 2:SUITE 10C
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-2905
Practice Address - Country:US
Practice Address - Phone:609-654-8640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00191600103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist