MEDICARE: DR. DANIEL SILITSKY PH.D., ED.S., CHT,

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	101YP2500X	Professional Counselor	6180055	NJ
2	106H00000X	Marriage & Family Therapist	37FI00124400	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6180055	OTHER	NJ	PROFESSIONAL
2	37FI00124400	OTHER	NJ	NJ LICENSED MARRIAGE AND FAMILY THERAPIST
3	0300-072447	OTHER	NJ	CERTIFIED HYPNOTHERAPIST

General Provider Information

NPI Number	:	1730477415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL SILITSKY PH.D., ED.S., CHT,

Provider Business Mailing Address
First Line	:	11 VAN HISE CT
Second Line	:
City	:	EAST BRUNSWICK
State	:	NJ
Zip	:	08816-3439
Country	:	US
Telephone Number	:	732-718-3535
Fax Number	:	732-698-0335

Provider Business Practice Location Address
First Line	:	197 ROUTE 18
Second Line	:	SUITE 235
City	:	EAST BRUNSWICK
State	:	NJ
Zip	:	08816-1440
Country	:	US
Telephone Number	:	732-718-3535
Fax Number	:	732-698-0335

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

Provider Enumeration Date	:	07/15/2011
Last Update Date	:	07/15/2011

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