Healthcare Provider Details

I. General information

NPI: 1457573644
Provider Name (Legal Business Name): NANCY T. BLOCK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 10/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 CROMWELL CT
BERKELEY HEIGHTS NJ
07922-1828
US

IV. Provider business mailing address

87 CROMWELL CT
BERKELEY HEIGHTS NJ
07922-1828
US

V. Phone/Fax

Practice location:
  • Phone: 908-464-2174
  • Fax: 908-464-4353
Mailing address:
  • Phone: 908-464-2174
  • Fax: 908-464-4353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number25MA0169800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MA01696800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: