MEDICARE: DR. JAY PAUL GRANAT PHD LMFT

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
1	103T00000X	Psychologist	37F100078200	NJ

General Provider Information

NPI Number	:	1174608178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAY PAUL GRANAT PHD LMFT

Provider Business Mailing Address
First Line	:	1060 MAIN STREET
Second Line	:	SUITE 307
City	:	RIVER EDGE
State	:	NJ
Zip	:	07661
Country	:	US
Telephone Number	:	201-342-3663
Fax Number	:	201-342-2258

Provider Business Practice Location Address
First Line	:	1060 MAIN STREET
Second Line	:	SUITE 307
City	:	RIVER EDGE
State	:	NJ
Zip	:	07661
Country	:	US
Telephone Number	:	201-342-3663
Fax Number	:	201-342-2258

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	07/08/2007

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