Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 35SI00356200 | NJ |
Y | 103TC0700X | Clinical Psychologist | 35SI00356200 | NJ |
NPI | 1003095134 |
---|---|
Provider Name | Lydia Zborowski Golub |
First Address | Upper Montclair, NJ 07043-2005 |
Second Address | Upper Montclair, NJ 07043-1320 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2007 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
35SI00356200 | MEDICAL LICENSE # (01) | NJ |