Healthcare Provider Details

I. General information

NPI: 1700362464
Provider Name (Legal Business Name): ELIZABETH NISSIM PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2018
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 W MOUNT PLEASANT AVE STE 212&322
LIVINGSTON NJ
07039-1710
US

IV. Provider business mailing address

12 IRON FORGE RD
PARSIPPANY NJ
07054-4308
US

V. Phone/Fax

Practice location:
  • Phone: 973-309-3262
  • Fax: 973-200-2580
Mailing address:
  • Phone: 973-953-9123
  • Fax: 973-200-2580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number35S100427300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: