Healthcare Provider Details

I. General information

NPI: 1790691756
Provider Name (Legal Business Name): AMIR SARRAFIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 KLINE BLVD
COLONIA NJ
07067-1922
US

IV. Provider business mailing address

72 KLINE BLVD
COLONIA NJ
07067-1922
US

V. Phone/Fax

Practice location:
  • Phone: 732-770-2384
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number37PC01228900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: