Provider Demographics
NPI:1568656106
Name:LOBL, PETER WALTER (PH D)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:WALTER
Last Name:LOBL
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 MADISON AVE
Mailing Address - Street 2:SUITE 704
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-0701
Mailing Address - Country:US
Mailing Address - Phone:917-392-9744
Mailing Address - Fax:
Practice Address - Street 1:274 MADISON AVE
Practice Address - Street 2:SUITE 704
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-0701
Practice Address - Country:US
Practice Address - Phone:917-392-9744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017265-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical