=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528141231
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROSEANNE D DOBKIN PHD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2006
-----------------------------------------------------
Last Update Date | 07/23/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 671 HOES LN W STE 338A
-----------------------------------------------------
City | PISCATAWAY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08854-8021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-235-7647
-----------------------------------------------------
Fax | 732-235-4220
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 66 W GILBERT ST 2ND FLOOR
-----------------------------------------------------
City | TINTON FALLS
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07701-4947
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-212-0051
-----------------------------------------------------
Fax | 732-212-0713
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 35SI00422000
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------