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General NPI Number Information
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NPI Number | 1750413217
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Entity Type | Organization
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Legal Business Name | MARK S. SOFAIR-FISCH, PHD
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Dates
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Enumeration Date | 03/11/2007
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Last Update Date | 05/13/2009
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Provider Practice Location Address
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Address Line | 2737 PRINCETON PIKE
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City | LAWRENCEVILLE
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State | NJ
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Zip | 08648-3220
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Country | US
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Telephone | 609-883-2577
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Fax | 609-883-2092
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Provider Business Mailing Address
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Address Line | 5 ELLIS ST
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City | WEST ORANGE
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State | NJ
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Zip | 07052-3612
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Country | US
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Telephone | 973-669-3333
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Fax | 973-669-9675
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. MARK S. SOFAIR-FISCH
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Credential | PHD
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Telephone | 973-669-3333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 37LC000043500
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 35S100432500
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License Number State | NJ
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