Provider Demographics
NPI:1104900729
Name:ADAMOYURKA, ELLEN (PHD, PSYD)
Entity type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:
Last Name:ADAMOYURKA
Suffix:
Gender:F
Credentials:PHD, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 N BEERS ST
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1524
Mailing Address - Country:US
Mailing Address - Phone:732-264-2440
Mailing Address - Fax:
Practice Address - Street 1:717 N BEERS ST
Practice Address - Street 2:
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1524
Practice Address - Country:US
Practice Address - Phone:732-264-2440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100181400103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJJO 169 83OtherCHAMPUS
NJAD 454 605Medicare ID - Type Unspecified