Provider Demographics
NPI:1275961229
Name:OSTELSEN
Entity Type:Organization
Organization Name:OSTELSEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ELVIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALER
Authorized Official - Suffix:
Authorized Official - Credentials:EDD,LCSW
Authorized Official - Phone:201-873-5575
Mailing Address - Street 1:1203 RIVER RD
Mailing Address - Street 2:#9M
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-1456
Mailing Address - Country:US
Mailing Address - Phone:201-873-5575
Mailing Address - Fax:
Practice Address - Street 1:212 WHITEMAN ST
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-6920
Practice Address - Country:US
Practice Address - Phone:201-873-5575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05280200103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealthGroup - Multi-Specialty