Provider Demographics
NPI:1790139566
Name:CRIST, PETER ALAN
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:ALAN
Last Name:CRIST
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:PETER
Other - Middle Name:ALAN
Other - Last Name:CRIST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 420
Mailing Address - Street 2:
Mailing Address - City:RINGOES
Mailing Address - State:NJ
Mailing Address - Zip Code:08551-0420
Mailing Address - Country:US
Mailing Address - Phone:609-397-5729
Mailing Address - Fax:609-397-7972
Practice Address - Street 1:62 WAGNER RD
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:NJ
Practice Address - Zip Code:08559-1412
Practice Address - Country:US
Practice Address - Phone:609-397-5729
Practice Address - Fax:609-397-7972
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA037893002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry