Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | NJ1755 | NJ |
Y | 103T00000X | Psychologist | NJ1755 | NJ |
NPI | 1013054683 |
---|---|
Provider Name | Dr. Robert J. Pasahow |
First Address | Northfield, NJ 08225-1653 |
Second Address | Northfield, NJ 08225-1653 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
R31213 | (02) | NJ |