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General NPI Number Information
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NPI Number | 1336964659
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Entity Type | Individual
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Provider Name | BERTALAN KORMANN
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Gender | Male
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Dates
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Enumeration Date | 11/21/2024
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 700 AIRPORT RD
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City | LAKEWOOD
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State | NJ
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Zip | 08701-5907
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Country | US
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Telephone | 732-367-4700
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Fax |
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Provider Business Mailing Address
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Address Line | 56 DEKKER CT
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City | BRICK
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State | NJ
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Zip | 08724-2435
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Country | US
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Telephone | 732-822-4165
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 37PC00245100
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License Number State | NJ
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