MEDICARE: JACOB KIRSCHENBAUM PH.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	35S100218900	NJ

General Provider Information

NPI Number	:	1922180561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB KIRSCHENBAUM PH.D.

Provider Business Mailing Address
First Line	:	315A FORSGATE DR
Second Line	:
City	:	MONROE
State	:	NJ
Zip	:	08831-1539
Country	:	US
Telephone Number	:	732-521-3600
Fax Number	:	732-521-3603

Provider Business Practice Location Address
First Line	:	315A FORSGATE DR
Second Line	:
City	:	MONROE
State	:	NJ
Zip	:	08831-1539
Country	:	US
Telephone Number	:	732-521-3600
Fax Number	:	732-521-3603

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

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	05/09/2015

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