Healthcare Provider Details

I. General information

NPI: 1164686325
Provider Name (Legal Business Name): JENNIFER KRAKER MD, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2008
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 E 42ND ST RM 3006
NEW YORK NY
10168-3095
US

IV. Provider business mailing address

122 E 42ND ST RM 3006
NEW YORK NY
10168-3095
US

V. Phone/Fax

Practice location:
  • Phone: 646-813-3750
  • Fax: 646-701-5655
Mailing address:
  • Phone: 646-813-3750
  • Fax: 646-701-5655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number257741
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number257741
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberC184648
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME160250
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101287718
License Number StateVA
# 6
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC184648
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number0101287718
License Number StateVA
# 8
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License NumberME160250
License Number StateFL
# 9
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberME160250
License Number StateFL
# 10
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number257741
License Number StateNY
# 11
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License NumberC184648
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: