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General NPI Number Information
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NPI Number | 1962722306
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Entity Type | Organization
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Legal Business Name | EDWARD T. MANN, PHD, P.A.
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Dates
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Enumeration Date | 06/08/2010
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Last Update Date | 06/08/2010
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Provider Practice Location Address
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Address Line | 205 RIDGEDALE AVE
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City | FLORHAM PARK
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State | NJ
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Zip | 07932-1349
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Country | US
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Telephone | 973-966-0057
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Fax |
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Provider Business Mailing Address
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Address Line | 205 RIDGEDALE AVE P. O. BOX 239
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City | FLORHAM PARK
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State | NJ
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Zip | 07932-1349
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Country | US
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Telephone | 973-966-0057
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EDWARD THOMAS MANN
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Credential | PH.D.
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Telephone | 973-966-0057
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 35SI00091500
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License Number State | NJ
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