=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023132917
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARUTA FRIEDLER PSY.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/18/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 28 BEECHWOOD RD
-----------------------------------------------------
City | SUMMIT
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07901-2532
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-522-9595
-----------------------------------------------------
Fax | 212-439-6751
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 311 E 72ND ST 9B
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10021-4684
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-439-6751
-----------------------------------------------------
Fax | 212-439-6751
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 35S100276400
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------