Provider Demographics
NPI:1649648544
Name:PSYCHOLOGY GROUP OF NORTHERN NEW JERSEY
Entity type:Organization
Organization Name:PSYCHOLOGY GROUP OF NORTHERN NEW JERSEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:HERTLER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:201-652-6843
Mailing Address - Street 1:115 PINE ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-1619
Mailing Address - Country:US
Mailing Address - Phone:201-652-6843
Mailing Address - Fax:201-652-2187
Practice Address - Street 1:115 PINE ST
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-1619
Practice Address - Country:US
Practice Address - Phone:201-652-6843
Practice Address - Fax:201-652-2187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ5052103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty