Provider Demographics
NPI:1720296338
Name:MEZAN, PETER (PHD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:MEZAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:MR
Other - First Name:PETER
Other - Middle Name:
Other - Last Name:MEZAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:114 TODD RD
Mailing Address - Street 2:
Mailing Address - City:KATONAH
Mailing Address - State:NY
Mailing Address - Zip Code:10536-2514
Mailing Address - Country:US
Mailing Address - Phone:914-232-4693
Mailing Address - Fax:212-662-9574
Practice Address - Street 1:350 CENTRAL PARK W
Practice Address - Street 2:SUITE 2H
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6547
Practice Address - Country:US
Practice Address - Phone:212-662-0012
Practice Address - Fax:212-662-9574
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8434102L00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical