Healthcare Provider Details

I. General information

NPI: 1831500610
Provider Name (Legal Business Name): ELIZA BATLLE PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2014
Last Update Date: 08/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 E LAUREL RD STE 1100
STRATFORD NJ
08084-1354
US

IV. Provider business mailing address

42 E LAUREL RD STE 1100
STRATFORD NJ
08084-1354
US

V. Phone/Fax

Practice location:
  • Phone: 856-566-7036
  • Fax: 856-566-6108
Mailing address:
  • Phone: 856-566-7036
  • Fax: 856-566-6108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number35S100526900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: