MEDICARE: DR. PETER ALAN CRIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	25MA03789300	NJ

General Provider Information

NPI Number	:	1790139566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER ALAN CRIST

Provider Business Mailing Address
First Line	:	PO BOX 420
Second Line	:
City	:	RINGOES
State	:	NJ
Zip	:	08551-0420
Country	:	US
Telephone Number	:	609-397-5729
Fax Number	:	609-397-7972

Provider Business Practice Location Address
First Line	:	62 WAGNER RD
Second Line	:
City	:	STOCKTON
State	:	NJ
Zip	:	08559-1412
Country	:	US
Telephone Number	:	609-397-5729
Fax Number	:	609-397-7972

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2016
Last Update Date	:	04/19/2016

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Directions to “ DR. PETER ALAN CRIST ” Practice Location

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