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General NPI Number Information
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NPI Number | 1710471875
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Entity Type | Organization
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Legal Business Name | NEW JERSEY NEUROPSYCHOLOGY, LLC
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Dates
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Enumeration Date | 06/21/2018
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 27 CLYDE RD STE 102
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City | SOMERSET
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State | NJ
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Zip | 08873-5039
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Country | US
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Telephone | 908-418-1382
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Fax |
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Provider Business Mailing Address
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Address Line | 260 E BROAD ST APT 8
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City | WESTFIELD
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State | NJ
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Zip | 07090-5100
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Country | US
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Telephone | 908-418-1382
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Fax |
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Authorized Official
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Title or Position | CLINICAL NEUROPSYCHOLOGIST
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Name | DR. JOHN BRADLEY FECHTER
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Credential | PSYD
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Telephone | 908-418-1382
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 35S100594200
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License Number State | NJ
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