=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730482316
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | R.P.P. ON-SITE PSYCHOLOGY, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/21/2010
-----------------------------------------------------
Last Update Date | 12/21/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1221 JEROME AVE
-----------------------------------------------------
City | BRONX
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10452-3301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-796-6606
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 4071
-----------------------------------------------------
City | MIDDLETOWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07748-4071
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-576-1500
-----------------------------------------------------
Fax | 732-576-1542
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. STACEY COHEN-MEISSNER
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 917-796-6606
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 012780
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------