Provider Demographics
NPI:1093873689
Name:JORTNER, BARBARA (PSYD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:JORTNER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:386 PLAINFIELD RD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3045
Mailing Address - Country:US
Mailing Address - Phone:848-200-7328
Mailing Address - Fax:
Practice Address - Street 1:56 SEGUINE AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-3717
Practice Address - Country:US
Practice Address - Phone:908-272-4877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY010752103TC0700X
NJNJ2972103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV72331Medicare ID - Type Unspecified