Provider Demographics
NPI:1518031145
Name:RATHAUSER, JOHN HANS (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HANS
Last Name:RATHAUSER
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 1:3270 STATE ROUTE 27
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:KENDALL PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08824-1496
Mailing Address - Country:US
Mailing Address - Phone:732-297-5557
Mailing Address - Fax:
Practice Address - Street 1:3270 STATE ROUTE 27
Practice Address - Street 2:SUITE 1100
Practice Address - City:KENDALL PARK
Practice Address - State:NJ
Practice Address - Zip Code:08824-1496
Practice Address - Country:US
Practice Address - Phone:732-297-5557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1394103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJRA706467Medicare ID - Type Unspecified