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NPI Code Detail

MEDICARE: DR. RUTH LIJTMAER PHD

MEDICARE: DR. RUTH LIJTMAER PHD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist35S100158700NJ

General Provider Information

NPI Number : 1104960509
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RUTH LIJTMAER PHD
Provider Business Mailing Address
First Line : 88 W RIDGEWOOD AVE
Second Line :
City : RIDGEWOOD
State : NJ
Zip : 07450-3199
Country : US
Telephone Number : 201-445-5552
Fax Number : 201-444-2598
Provider Business Practice Location Address
First Line : 88 W RIDGEWOOD AVE
Second Line :
City : RIDGEWOOD
State : NJ
Zip : 07450-3199
Country : US
Telephone Number : 201-445-5552
Fax Number : 201-444-2598
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/18/2007
Last Update Date : 07/08/2007

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