Provider Demographics
NPI:1881924967
Name:KROLL, EVAN MICHAEL
Entity type:Individual
Prefix:DR
First Name:EVAN
Middle Name:MICHAEL
Last Name:KROLL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 STATE ST
Mailing Address - Street 2:SUITE 2D
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-5200
Mailing Address - Country:US
Mailing Address - Phone:201-384-6667
Mailing Address - Fax:
Practice Address - Street 1:100 STATE ST
Practice Address - Street 2:SUITE 2D
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-5200
Practice Address - Country:US
Practice Address - Phone:201-384-6667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4351103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent