Healthcare Provider Details

I. General information

NPI: 1811325152
Provider Name (Legal Business Name): AMY L. HRADIL PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2013
Last Update Date: 10/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2048 OAK TREE ROAD CENTER FOR HEAD INJURIES COGNITIVE REHABILITATION PROGR
EDISON NJ
08820
US

IV. Provider business mailing address

2048 OAK TREE ROAD CENTER FOR HEAD INJURIES COGNITIVE REHABILITATION PROGR
EDISON NJ
08820
US

V. Phone/Fax

Practice location:
  • Phone: 732-906-2640
  • Fax: 732-906-9241
Mailing address:
  • Phone: 732-906-2640
  • Fax: 732-906-9241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number35S100509600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number68019558
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: