Provider Demographics
NPI:1811325152
Name:HRADIL, AMY L (PHD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:HRADIL
Suffix:
Gender:F
Credentials:PHD
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2048 OAK TREE ROAD CENTER FOR HEAD INJURIES
Mailing Address - Street 2:COGNITIVE REHABILITATION PROGR
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820
Mailing Address - Country:US
Mailing Address - Phone:732-906-2640
Mailing Address - Fax:732-906-9241
Practice Address - Street 1:2048 OAK TREE ROAD CENTER FOR HEAD INJURIES
Practice Address - Street 2:COGNITIVE REHABILITATION PROGR
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820
Practice Address - Country:US
Practice Address - Phone:732-906-2640
Practice Address - Fax:732-906-9241
Is Sole Proprietor?:No
Enumeration Date:2013-10-24
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ35S100509600103G00000X
NY68019558103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical