Provider Demographics
NPI:1326161316
Name:SEIDEN, DOUGLAS (PHD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:
Last Name:SEIDEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 99
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-0099
Mailing Address - Country:US
Mailing Address - Phone:212-490-3590
Mailing Address - Fax:
Practice Address - Street 1:101 EISENHOWER PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:ROSELAND
Practice Address - State:NJ
Practice Address - Zip Code:07068-1032
Practice Address - Country:US
Practice Address - Phone:212-490-3590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014277-1103TC0700X
NJ35SI00394200103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP2721370OtherOXFORD
NYP2721370OtherOXFORD
NJ0007447266OtherAETNA
NY0007447266OtherAETNA
NJ555035000OtherMAGELLAN
NY555035000OtherMAGELLAN
NJ555035000OtherMAGELLAN
NJP2721370OtherOXFORD