Provider Demographics
NPI:1346389467
Name:OLDMAN, MARILYN (EDD)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:
Last Name:OLDMAN
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 ALEXANDRIA WAY
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920
Mailing Address - Country:US
Mailing Address - Phone:908-604-9681
Mailing Address - Fax:908-753-5775
Practice Address - Street 1:10 SHAWNEE DRIVE
Practice Address - Street 2:SUITE 7A
Practice Address - City:WATCHUNG
Practice Address - State:NJ
Practice Address - Zip Code:07069
Practice Address - Country:US
Practice Address - Phone:908-753-9797
Practice Address - Fax:908-753-5775
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2799103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
R33864Medicare UPIN