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General NPI Number Information
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NPI Number | 1912166356
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Entity Type | Individual
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Provider Name | PHYLLIS TOBIN PH.D.
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Gender | Female
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Dates
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Enumeration Date | 06/02/2008
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Last Update Date | 06/02/2008
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Provider Practice Location Address
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Address Line | 61 BAUER TER
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City | HILLSIDE
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State | NJ
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Zip | 07205-3002
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Country | US
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Telephone | 908-351-3512
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Fax | 908-354-7440
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Provider Business Mailing Address
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Address Line | 260 W 72ND ST
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City | NEW YORK
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State | NY
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Zip | 10023-2817
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Country | US
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Telephone | 212-877-5353
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Fax | 908-354-7440
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 003612-1
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License Number State | NY
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