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General NPI Number Information
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NPI Number | 1962617811
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Entity Type | Individual
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Provider Name | DAVID M MAHALICK PH.D.
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Gender | Male
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 10/06/2014
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Provider Practice Location Address
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Address Line | 2066 MILLBURN AVE SUITE 201
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City | MAPLEWOOD
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State | NJ
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Zip | 07040-3727
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Country | US
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Telephone | 908-832-6629
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Fax | 973-313-1666
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Provider Business Mailing Address
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Address Line | 2066 MILLBURN AVE SUITE 201
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City | MAPLEWOOD
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State | NJ
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Zip | 07040-3727
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Country | US
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Telephone | 973-313-9393
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Fax | 973-313-1666
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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 | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 2582
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 013948DUP
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License Number State | NY
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