Provider Demographics
NPI:1245546696
Name:PIEPGRAS, JOHN PETER (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PETER
Last Name:PIEPGRAS
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 1:3268 MIDDLETOWN RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-1040
Mailing Address - Country:US
Mailing Address - Phone:646-228-0079
Mailing Address - Fax:
Practice Address - Street 1:3268 MIDDLETOWN RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-1040
Practice Address - Country:US
Practice Address - Phone:646-228-0079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY68017714103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical