Provider Demographics
NPI:1720206246
Name:MORRIS LAITMAN P A
Entity Type:Organization
Organization Name:MORRIS LAITMAN P A
Other - Org Name:LAITMAN P A
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MORRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LAITMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:732-571-3950
Mailing Address - Street 1:9 ABIS PL
Mailing Address - Street 2:
Mailing Address - City:WEST LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07764-1104
Mailing Address - Country:US
Mailing Address - Phone:732-571-3950
Mailing Address - Fax:732-571-6807
Practice Address - Street 1:9 ABIS PL
Practice Address - Street 2:
Practice Address - City:WEST LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07764-1104
Practice Address - Country:US
Practice Address - Phone:732-571-3950
Practice Address - Fax:732-571-6807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00011800103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ035216Medicare ID - Type Unspecified