Healthcare Provider Details

I. General information

NPI: 1952325730
Provider Name (Legal Business Name): JOSEPH E CONROY PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 08/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1859 N PARIS AVE SUITE 212
PORT ROYAL SC
29935-2029
US

IV. Provider business mailing address

1859 N PARIS AVE SUITE 212
PORT ROYAL SC
29935-2029
US

V. Phone/Fax

Practice location:
  • Phone: 732-859-0213
  • Fax: 800-853-3788
Mailing address:
  • Phone: 732-859-0213
  • Fax: 800-853-3788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number3356
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: