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General NPI Number Information
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NPI Number | 1023134186
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Entity Type | Organization
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Legal Business Name | WAYNE PSYCHOLOGICAL GROUP LLC
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 04/29/2009
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Provider Practice Location Address
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Address Line | 45 CAREY AVE SUITE 204
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City | BUTLER
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State | NJ
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Zip | 07405-1443
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Country | US
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Telephone | 973-527-4411
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Fax | 973-527-4409
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Provider Business Mailing Address
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Address Line | 45 CAREY AVE SUITE 204
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City | BUTLER
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State | NJ
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Zip | 07405-1443
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Country | US
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Telephone | 973-527-4411
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Fax | 973-527-4409
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Authorized Official
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Title or Position | MEMBER
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Name | DR. EMILE BERTRAND GURSTELLE
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Credential | PH.D.
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Telephone | 973-527-4411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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