Basic Information
| Provider Information | |||||||||
| NPI: | 1386692838 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KRATKA | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6257 | ||||||||
| Address2: | |||||||||
| City: | ASTORIA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 111060257 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182044995 | ||||||||
| FaxNumber: | 7182743792 | ||||||||
| Practice Location | |||||||||
| Address1: | 8940 56TH AVE | ||||||||
| Address2: | |||||||||
| City: | ELMHURST | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113734933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183355532 | ||||||||
| FaxNumber: | 7185050241 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2006 | ||||||||
| LastUpdateDate: | 08/06/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 162878 | NY | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 300138039 | 01 | RAILROAD MEDICARE | OTHER | 01128129 | 05 | NY | MEDICAID | 300061751 | 01 | RAILROAD MEDICARE | OTHER | 300138026 | 01 | RAILROAD MEDICARE | OTHER | 300016494 | 01 | RAILROAD MEDICARE | OTHER |