Healthcare Provider Details

I. General information

NPI: 1306984380
Provider Name (Legal Business Name): THOMAS R FOWLER PSY. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 SUMMIT AVE
HACKENSACK NJ
07601-1262
US

IV. Provider business mailing address

83 SUMMIT AVE
HACKENSCK NJ
07601
US

V. Phone/Fax

Practice location:
  • Phone: 201-488-6678
  • Fax: 201-224-0599
Mailing address:
  • Phone: 201-488-6678
  • Fax: 201-224-0599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number35S100437300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number35S100437300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: