=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275545915
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRAD M WOLFF PHD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/12/2006
-----------------------------------------------------
Last Update Date | 09/24/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 104 TAYLOR MILLS RD
-----------------------------------------------------
City | MANALAPAN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07726-3419
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-792-0500
-----------------------------------------------------
Fax | 732-792-2715
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 104 TAYLOR MILLS RD
-----------------------------------------------------
City | MANALAPAN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07726-3419
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-792-0500
-----------------------------------------------------
Fax | 732-792-2715
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED PSYCHOLOGIST
-----------------------------------------------------
Name | DR. BRAD M WOLFF
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 732-792-0500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 35SI0014200
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------