Basic Information
| Provider Information | |||||||||
| NPI: | 1215159736 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WAIZER | ||||||||
| FirstName: | JONAS | ||||||||
| MiddleName: | I | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 35 EDGEMOUNT RD | ||||||||
| Address2: | |||||||||
| City: | EDISON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088172904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7325725192 | ||||||||
| FaxNumber: | 2123668441 | ||||||||
| Practice Location | |||||||||
| Address1: | 315 HUDSON ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100131009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123668024 | ||||||||
| FaxNumber: | 2123668441 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 005177-1 | NY | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.