Provider Demographics
NPI:1962577460
Name:BURDMAN, LOUIS (PHD)
Entity type:Individual
Prefix:
First Name:LOUIS
Middle Name:
Last Name:BURDMAN
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 1:619 WOODFIELD RD
Mailing Address - Street 2:
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481-1422
Mailing Address - Country:US
Mailing Address - Phone:201-847-1148
Mailing Address - Fax:
Practice Address - Street 1:180 RAMAPO VALLEY RD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:NJ
Practice Address - Zip Code:07436-2524
Practice Address - Country:US
Practice Address - Phone:201-790-3461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100347100103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7259506Medicaid
NJ903971Medicare ID - Type Unspecified