Healthcare Provider Details

I. General information

NPI: 1639400633
Provider Name (Legal Business Name): ERIC A. MARGENAU PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2010
Last Update Date: 01/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 MATTISON RD
BRANCHVILLE NJ
07826-4002
US

IV. Provider business mailing address

3777 INDEPENDENCE AVE. APT. #4H
BRONX NY
10463-1414
US

V. Phone/Fax

Practice location:
  • Phone: 646-265-4827
  • Fax: 347-964-5417
Mailing address:
  • Phone: 646-265-4827
  • Fax: 347-964-5417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number35SI00166800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: