Provider Demographics
NPI:1417976820
Name:MEDNICK, DAVID (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:MEDNICK
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 ESSEX ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-3246
Mailing Address - Country:US
Mailing Address - Phone:201-881-0111
Mailing Address - Fax:201-487-2853
Practice Address - Street 1:211 ESSEX ST
Practice Address - Street 2:SUITE 304
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-3246
Practice Address - Country:US
Practice Address - Phone:201-881-0111
Practice Address - Fax:201-487-2853
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSI02963103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist