Provider Demographics
NPI:1508928599
Name:PANTER, RORY A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RORY
Middle Name:A
Last Name:PANTER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 ELM ST
Mailing Address - Street 2:APT 4
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-2172
Mailing Address - Country:US
Mailing Address - Phone:571-235-4901
Mailing Address - Fax:
Practice Address - Street 1:35 CLYDE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-5033
Practice Address - Country:US
Practice Address - Phone:571-235-4901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S10049400103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWVE061Medicare ID - Type UnspecifiedAGENCY MEDICARE PROVIDER#
NY1285628552OtherAGENCY NPI
NY00355940OtherAGENCY MEDICAID #