Provider Demographics
NPI:1558399543
Name:GINA E. RAYFIELD, PH.D., PC
Entity Type:Organization
Organization Name:GINA E. RAYFIELD, PH.D., PC
Other - Org Name:GINA E. RAYFIELD & ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GINA
Authorized Official - Middle Name:EVE
Authorized Official - Last Name:RAYFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:973-927-1818
Mailing Address - Street 1:24 E LOGAN RD
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-2622
Mailing Address - Country:US
Mailing Address - Phone:973-927-1818
Mailing Address - Fax:973-927-1679
Practice Address - Street 1:24 E LOGAN RD
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-2622
Practice Address - Country:US
Practice Address - Phone:973-927-1818
Practice Address - Fax:973-927-1679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSI 2293103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4992202Medicaid
NJRA484576Medicare ID - Type UnspecifiedPROVIDER #