Provider Demographics
NPI:1770643900
Name:AYLWARD, JOHN L (EDD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:L
Last Name:AYLWARD
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 JOHNSTON DRIVE
Mailing Address - Street 2:
Mailing Address - City:WATCHUNG
Mailing Address - State:NJ
Mailing Address - Zip Code:07069-4905
Mailing Address - Country:US
Mailing Address - Phone:908-757-4921
Mailing Address - Fax:908-757-6860
Practice Address - Street 1:32 JOHNSTON DRIVE
Practice Address - Street 2:
Practice Address - City:WATCHUNG
Practice Address - State:NJ
Practice Address - Zip Code:07069-4905
Practice Address - Country:US
Practice Address - Phone:908-757-4921
Practice Address - Fax:908-757-6860
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1670103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ426471Medicare UPIN
NJ426471Medicare ID - Type UnspecifiedMEDICARE#