Healthcare Provider Details

I. General information

NPI: 1073474466
Provider Name (Legal Business Name): OM PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

482 SPRINGFIELD AVE FL 2
SUMMIT NJ
07901-2601
US

IV. Provider business mailing address

482 SPRINGFIELD AVE FL 2
SUMMIT NJ
07901-2601
US

V. Phone/Fax

Practice location:
  • Phone: 908-273-5558
  • Fax: 908-273-3355
Mailing address:
  • Phone: 908-273-5558
  • Fax: 908-273-3355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. VASUDEV DIXIT
Title or Position: MANAGING DIRECTOR
Credential: PH.D.
Phone: 908-273-5558