Healthcare Provider Details

I. General information

NPI: 1063335743
Provider Name (Legal Business Name): BOMZER PSYCHOLOGICAL ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5-02 BRYANT PL
FAIR LAWN NJ
07410-2175
US

IV. Provider business mailing address

5-02 BRYANT PL
FAIR LAWN NJ
07410-2175
US

V. Phone/Fax

Practice location:
  • Phone: 917-374-3074
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. PHILIP BOMZER
Title or Position: OWNER
Credential:
Phone: 917-374-3074