Healthcare Provider Details

I. General information

NPI: 1922764273
Provider Name (Legal Business Name): DOUGLAS EDMUND RYNKEWICZ MA, EDS, LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2021
Last Update Date: 11/11/2021
Certification Date: 11/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 WOODLANE RD STE 300
WESTAMPTON NJ
08060-3832
US

IV. Provider business mailing address

514 HARBOUR DR APT B
BENSALEM PA
19020-6120
US

V. Phone/Fax

Practice location:
  • Phone: 609-267-1377
  • Fax:
Mailing address:
  • Phone: 609-658-3426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number1094746
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37AC00440200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: