Healthcare Provider Details

I. General information

NPI: 1861760589
Provider Name (Legal Business Name): PEGGY KAREN KRAUS CDE. RCEP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2011
Last Update Date: 04/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

349 MEETING HOUSE LN
SOUTHAMPTON NY
11968-5051
US

IV. Provider business mailing address

82 SPRINGVILLE ROAD
HAMPTON BAYS NY
11946-2453
US

V. Phone/Fax

Practice location:
  • Phone: 631-377-3630
  • Fax: 631-377-3631
Mailing address:
  • Phone: 631-728-5575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code224Y00000X
TaxonomyClinical Exercise Physiologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: