Healthcare Provider Details

I. General information

NPI: 1386494482
Provider Name (Legal Business Name): JAYNA EWALD PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 MADISON AVE
WYCKOFF NJ
07481-1949
US

IV. Provider business mailing address

234 MADISON AVE
WYCKOFF NJ
07481-1949
US

V. Phone/Fax

Practice location:
  • Phone: 201-252-2528
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number35SI00815200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY10000889
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: