Provider Demographics
NPI:1215141270
Name:MILCHMAN, MADELYN SIMRING (PHD)
Entity type:Individual
Prefix:DR
First Name:MADELYN
Middle Name:SIMRING
Last Name:MILCHMAN
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 1:243 N MOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:UPPER MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-1001
Mailing Address - Country:US
Mailing Address - Phone:973-783-6235
Mailing Address - Fax:973-655-1386
Practice Address - Street 1:243 N MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:UPPER MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1001
Practice Address - Country:US
Practice Address - Phone:973-783-6235
Practice Address - Fax:973-655-1386
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ02198103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ536483Medicare ID - Type Unspecified