Healthcare Provider Details

I. General information

NPI: 1689764524
Provider Name (Legal Business Name): CURTIS H WAECHTLER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2106 NEW RD SUITE F-3
LINWOOD NJ
08221-1046
US

IV. Provider business mailing address

507 VALLEY VIEW RD
MERION STATION PA
19066-1317
US

V. Phone/Fax

Practice location:
  • Phone: 610-574-3367
  • Fax:
Mailing address:
  • Phone: 610-617-3676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number35S100423300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPS007930L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberB1-0000609
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: