Healthcare Provider Details

I. General information

NPI: 1952593212
Provider Name (Legal Business Name): JOHN J. COLYAR, JR., PH.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2007
Last Update Date: 09/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 W MAPLE AVE
MERCHANTVILLE NJ
08109-2038
US

IV. Provider business mailing address

109 W MAPLE AVE
MERCHANTVILLE NJ
08109-2038
US

V. Phone/Fax

Practice location:
  • Phone: 856-661-0324
  • Fax:
Mailing address:
  • Phone: 856-661-0324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberSI02758
License Number StateNJ

VIII. Authorized Official

Name: DR. JOHN JOSEPH COLYAR JR.
Title or Position: OWNER/LICENSED PSYCHOLOGIST
Credential: PH.D.
Phone: 856-661-0324