Provider Demographics
NPI:1629097449
Name:WULACH, JAMES S (PHD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:S
Last Name:WULACH
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 1:30 PARK RD
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-2216
Mailing Address - Country:US
Mailing Address - Phone:973-763-4588
Mailing Address - Fax:
Practice Address - Street 1:206 MAIN ST.
Practice Address - Street 2:SUITE 22
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1161
Practice Address - Country:US
Practice Address - Phone:973-763-4588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35 SI 00 1299 00103T00000X, 103TC0700X
NY005829-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ053646Medicare PIN