Healthcare Provider Details

I. General information

NPI: 1275061392
Provider Name (Legal Business Name): THOMAS J DREXLER PSYCHOLOGY BA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2017
Last Update Date: 06/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

93 W. PALISADES AVE
ENGLEWOOD NJ
07631
US

IV. Provider business mailing address

2 PARK AVE VANTAGE HEALTH SYSTEM
DUMONT NJ
07628
US

V. Phone/Fax

Practice location:
  • Phone: 201-567-0500
  • Fax: 201-567-9335
Mailing address:
  • Phone: 201-385-4400
  • Fax: 201-385-9689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: