Provider Demographics
NPI:1558583070
Name:FOGEL, RESA SCHLEIFER
Entity Type:Individual
Prefix:DR
First Name:RESA
Middle Name:SCHLEIFER
Last Name:FOGEL
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:RESA
Other - Middle Name:
Other - Last Name:FOGEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:265 CEDAR LANE
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066
Mailing Address - Country:US
Mailing Address - Phone:973-931-8696
Mailing Address - Fax:
Practice Address - Street 1:265 CEDAR LN
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-3444
Practice Address - Country:US
Practice Address - Phone:973-931-8696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100347800103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical