1184171464 NPI number — ELLEN M HERR-ISRAEL PH D LLC

Table of content: (NPI 1184171464)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184171464 NPI number — ELLEN M HERR-ISRAEL PH D LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELLEN M HERR-ISRAEL PH D LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
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NPI Number Information

NPI Number:
1184171464
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/31/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
166 BUNN DR STE 102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRINCETON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08540-2800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-625-1534
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
166 BUNN DR STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRINCETON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08540-2800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-625-1534
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/05/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HERR-ISRAEL
Authorized Official First Name:
ELLEN
Authorized Official Middle Name:
Authorized Official Title or Position:
PSYCHOLOGIST
Authorized Official Telephone Number:
908-625-1534

Provider Taxonomy Codes

  • Taxonomy code: 103TF0000X , with the licence number:  35SI00563100 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)