MEDICARE: DR. RESA SCHLEIFER FOGEL

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	103TC0700X	Clinical Psychologist	35S100347800	NJ

General Provider Information

NPI Number	:	1558583070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RESA SCHLEIFER FOGEL

Provider Business Mailing Address
First Line	:	265 CEDAR LANE
Second Line	:
City	:	TEANECK
State	:	NJ
Zip	:	07066
Country	:	US
Telephone Number	:	973-931-8696
Fax Number	:

Provider Business Practice Location Address
First Line	:	265 CEDAR LN
Second Line	:
City	:	TEANECK
State	:	NJ
Zip	:	07666-3444
Country	:	US
Telephone Number	:	973-931-8696
Fax Number	:

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

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	02/26/2015

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