Healthcare Provider Details

I. General information

NPI: 1902742752
Provider Name (Legal Business Name): RUBY YEDLOUTSCHNIG, PSYD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 W BRADFORD AVE
CEDAR GROVE NJ
07009-1803
US

IV. Provider business mailing address

67 W BRADFORD AVE
CEDAR GROVE NJ
07009-1803
US

V. Phone/Fax

Practice location:
  • Phone: 973-830-1057
  • Fax: 973-559-8638
Mailing address:
  • Phone: 973-830-1057
  • Fax: 973-559-8638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: RUBY YEDLOUTSCHNIG
Title or Position: OWNER
Credential: PSYD
Phone: 973-830-1057