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NPI Code Detail

MEDICARE: SUPPORTIVE CARE PSYCHOLOGY OF NJ PC

MEDICARE: SUPPORTIVE CARE PSYCHOLOGY OF NJ PC
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
1103TC0700XClinical Psychologist

General Provider Information

NPI Number : 1356840003
Entity Type Code : Organization
Provider Name (Legal Business Name) : SUPPORTIVE CARE PSYCHOLOGY OF NJ PC
Provider Business Mailing Address
First Line : 27 RANDOLPH RD
Second Line :
City : HOWELL
State : NJ
Zip : 07731-8611
Country : US
Telephone Number : 718-298-4375
Fax Number :
Provider Business Practice Location Address
First Line : 27 RANDOLPH RD
Second Line :
City : HOWELL
State : NJ
Zip : 07731-8611
Country : US
Telephone Number : 718-298-4375
Fax Number :
Authorized Official
Title or Position : CEO
Name : DOV NEWMARK
Credential :
Telephone Number : 732-298-2753
Provider Enumeration Date : 02/08/2018
Last Update Date : 02/08/2018

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