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General NPI Number Information
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NPI Number | 1962742932
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Entity Type | Individual
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Provider Name | JED E BAKER PHD
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Gender | Male
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Dates
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Enumeration Date | 02/27/2013
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Last Update Date | 02/27/2013
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Provider Practice Location Address
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Address Line | 28 MILLBURN AVE, SUITE 7
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City | SPRINGFIELD
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State | NJ
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Zip | 07081
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Country | US
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Telephone | 973-313-1803
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Fax |
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Provider Business Mailing Address
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Address Line | 29 COLLINWOOD RD
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City | MAPLEWOOD
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State | NJ
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Zip | 07040-1035
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Country | US
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Telephone | 973-313-1803
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Fax |
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 35SI00331400
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License Number State | NJ
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