1275061392 NPI number — MR. THOMAS J DREXLER PSYCHOLOGY BA

Table of content: MR. THOMAS J DREXLER PSYCHOLOGY BA (NPI 1275061392)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275061392 NPI number — MR. THOMAS J DREXLER PSYCHOLOGY BA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DREXLER
Provider First Name:
THOMAS
Provider Middle Name:
J
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PSYCHOLOGY BA
Provider Gender Code:
M

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:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275061392
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/02/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 PARK AVE
Provider Second Line Business Mailing Address:
VANTAGE HEALTH SYSTEM
Provider Business Mailing Address City Name:
DUMONT
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07628
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-385-4400
Provider Business Mailing Address Fax Number:
201-385-9689

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
93 W. PALISADES AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENGLEWOOD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-567-0500
Provider Business Practice Location Address Fax Number:
201-567-9335
Provider Enumeration Date:
06/02/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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