Provider Demographics
NPI:1104960509
Name:LIJTMAER, RUTH (PHD)
Entity type:Individual
Prefix:DR
First Name:RUTH
Middle Name:
Last Name:LIJTMAER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 W RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3199
Mailing Address - Country:US
Mailing Address - Phone:201-445-5552
Mailing Address - Fax:201-444-2598
Practice Address - Street 1:88 W RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3199
Practice Address - Country:US
Practice Address - Phone:201-445-5552
Practice Address - Fax:201-444-2598
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100158700103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ650315Medicare ID - Type UnspecifiedPSYCHOLOGIST