Provider Demographics
NPI:1750413217
Name:MARK S. SOFAIR-FISCH, PHD
Entity type:Organization
Organization Name:MARK S. SOFAIR-FISCH, PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:SOFAIR-FISCH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:973-669-3333
Mailing Address - Street 1:5 ELLIS ST
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-3612
Mailing Address - Country:US
Mailing Address - Phone:973-669-3333
Mailing Address - Fax:973-669-9675
Practice Address - Street 1:2737 PRINCETON PIKE
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-3220
Practice Address - Country:US
Practice Address - Phone:609-883-2577
Practice Address - Fax:609-883-2092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-11
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC000043500101YA0400X
NJ35S100432500103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ469819000OtherMAGELLAN