1437265568 NPI number — MR. ROGER MAITLAND PHD PSYCHOLOGY

Table of content: MR. ROGER MAITLAND PHD PSYCHOLOGY (NPI 1437265568)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437265568 NPI number — MR. ROGER MAITLAND PHD PSYCHOLOGY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAITLAND
Provider First Name:
ROGER
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PHD PSYCHOLOGY
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MAITLAND
Provider Other First Name:
ROGER
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1437265568
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 885
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLARK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07066
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-381-6118
Provider Business Mailing Address Fax Number:
732-381-3491

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
999 RARITAN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-381-6118
Provider Business Practice Location Address Fax Number:
732-381-3491
Provider Enumeration Date:
08/22/2006

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: 103T00000X , with the licence number:  2387 , 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)





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