Provider Demographics
NPI:1437321908
Name:SOUTH JERSEY PSYCHOLOGY
Entity Type:Organization
Organization Name:SOUTH JERSEY PSYCHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:COFFEY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:732-286-2186
Mailing Address - Street 1:776 COMMONS WAY
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-6431
Mailing Address - Country:US
Mailing Address - Phone:732-286-2186
Mailing Address - Fax:732-286-2659
Practice Address - Street 1:776 COMMONS WAY
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-6431
Practice Address - Country:US
Practice Address - Phone:732-286-2186
Practice Address - Fax:732-286-2659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ002659103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ616589Medicare PIN