Provider Demographics
NPI:1962509042
Name:POMERANTZ, ROBERT MAYER (PHD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MAYER
Last Name:POMERANTZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 CORNELL RD
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-2104
Mailing Address - Country:US
Mailing Address - Phone:610-664-8519
Mailing Address - Fax:
Practice Address - Street 1:35 CORNELL RD
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-2104
Practice Address - Country:US
Practice Address - Phone:610-664-8519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS004363L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAS14029Medicare UPIN
PA762437Medicare ID - Type Unspecified