Provider Demographics
NPI:1679593339
Name:ARCHER, E WYMAN
Entity Type:Individual
Prefix:
First Name:E
Middle Name:WYMAN
Last Name:ARCHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 406153
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-1876
Mailing Address - Country:US
Mailing Address - Phone:973-584-2098
Mailing Address - Fax:973-584-2106
Practice Address - Street 1:71 SUNSET STRIP
Practice Address - Street 2:
Practice Address - City:SUCCASUNNA
Practice Address - State:NJ
Practice Address - Zip Code:07876-1311
Practice Address - Country:US
Practice Address - Phone:973-584-2098
Practice Address - Fax:973-584-2106
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MG00003100237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist