MEDICARE: DR. ALBERT JASON SULTAN PSY.D.

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	35SI00619000	NJ

General Provider Information

NPI Number	:	1902439987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALBERT JASON SULTAN PSY.D.

Provider Business Mailing Address
First Line	:	628 AVENUE V
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-4938
Country	:	US
Telephone Number	:	732-977-1958
Fax Number	:

Provider Business Practice Location Address
First Line	:	792 CHIMNEY ROCK RD STE C
Second Line	:
City	:	MARTINSVILLE
State	:	NJ
Zip	:	08836-2271
Country	:	US
Telephone Number	:	908-393-1533
Fax Number	:

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

Provider Enumeration Date	:	02/18/2020
Last Update Date	:	02/18/2020

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