Provider Demographics
NPI:1285716597
Name:NORTHMAN, JOHN E (PHD, ABPP)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:E
Last Name:NORTHMAN
Suffix:
Gender:M
Credentials:PHD, ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4955 N BAILEY AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-1206
Mailing Address - Country:US
Mailing Address - Phone:716-833-5930
Mailing Address - Fax:716-833-5954
Practice Address - Street 1:4955 N BAILEY AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-1206
Practice Address - Country:US
Practice Address - Phone:716-833-5930
Practice Address - Fax:716-833-5954
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5508103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY074721Medicare ID - Type Unspecified