Provider Demographics
NPI:1124278718
Name:MCNULTY, ANDREW JON (PSYD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JON
Last Name:MCNULTY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 212
Mailing Address - Street 2:
Mailing Address - City:SOUTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08879
Mailing Address - Country:US
Mailing Address - Phone:201-600-0044
Mailing Address - Fax:
Practice Address - Street 1:59 RARITAN REACH RD
Practice Address - Street 2:
Practice Address - City:SOUTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08879
Practice Address - Country:US
Practice Address - Phone:201-600-0044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-19
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ355100455500103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist