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General NPI Number Information
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NPI Number | 1417955238
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Entity Type | Individual
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Provider Name | GERALD ROBERT NATHAN PHD
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Gender | Male
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Dates
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Enumeration Date | 07/14/2005
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Last Update Date | 09/13/2008
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Provider Practice Location Address
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Address Line | 350 SPARTA AVE STE C-8
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City | SPARTA
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State | NJ
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Zip | 07871-1150
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Country | US
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Telephone | 973-729-4747
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Fax |
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Provider Business Mailing Address
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Address Line | 506 GRANDVIEW DR
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City | HIGHLAND LAKES
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State | NJ
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Zip | 07422-1606
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Country | US
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Telephone | 973-764-7961
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Fax | 973-764-9700
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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 | 3SSI00276200
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License Number State | NJ
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