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General NPI Number Information
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NPI Number | 1265437693
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Entity Type | Individual
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Provider Name | ALBERT ROGER GRIFFITH EDD
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Gender | Male
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Dates
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Enumeration Date | 06/13/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 17 ACADEMY ST STE 908
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City | NEWARK
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State | NJ
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Zip | 07102-2928
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Country | US
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Telephone | 973-624-4315
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Fax | 973-624-0012
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Provider Business Mailing Address
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Address Line | 270 EVERETT PL
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-1660
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Country | US
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Telephone | 291-568-3467
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 35S100149000
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License Number State | NJ
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