MEDICARE: DR. HENRY SREDNICKI 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
1	103T00000X	Psychologist	03509	NJ

General Provider Information

NPI Number	:	1255445326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HENRY SREDNICKI PHD

Provider Business Mailing Address
First Line	:	115 RELDYES AVE
Second Line	:
City	:	LEONIA
State	:	NJ
Zip	:	07605-1326
Country	:	US
Telephone Number	:	973-744-9130
Fax Number	:

Provider Business Practice Location Address
First Line	:	543 VALLEY RD
Second Line	:	SUITE 6
City	:	UPPER MONTCLAIR
State	:	NJ
Zip	:	07043-1881
Country	:	US
Telephone Number	:	973-744-9130
Fax Number	:

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

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	11/25/2014

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