MEDICARE: OSTELSEN

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	103TH0004X	Health Psychologist	44SC05280200	NJ

General Provider Information

NPI Number	:	1275961229
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OSTELSEN

Provider Business Mailing Address
First Line	:	1203 RIVER RD
Second Line	:	#9M
City	:	EDGEWATER
State	:	NJ
Zip	:	07020-1456
Country	:	US
Telephone Number	:	201-873-5575
Fax Number	:

Provider Business Practice Location Address
First Line	:	212 WHITEMAN ST
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-6920
Country	:	US
Telephone Number	:	201-873-5575
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. ELVIRA MALER
Credential	:	ED.D.,LCSW
Telephone Number	:	201-873-5575

Provider Enumeration Date	:	10/29/2013
Last Update Date	:	10/29/2013

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Directions to “OSTELSEN ” Practice Location

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