Healthcare Provider Details

I. General information

NPI: 1417183609
Provider Name (Legal Business Name): JEMOUR A MADDUX PSY.D., ABPP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2009
Last Update Date: 01/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 MAIN ST # 101-1
HACKENSACK NJ
07601-7113
US

IV. Provider business mailing address

90 MAIN ST # 101-1
HACKENSACK NJ
07601-7113
US

V. Phone/Fax

Practice location:
  • Phone: 212-810-6365
  • Fax:
Mailing address:
  • Phone: 212-810-6365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number0180691
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number35SI00482600
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: