Provider Demographics
NPI:1619371911
Name:BOKOR, PETER
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:BOKOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 RIVERSIDE DR APT 9A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-4115
Mailing Address - Country:US
Mailing Address - Phone:917-584-7726
Mailing Address - Fax:
Practice Address - Street 1:250 W. 57TH ST
Practice Address - Street 2:NIP
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10107
Practice Address - Country:US
Practice Address - Phone:212-582-1566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY093185-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker