Provider Demographics
NPI:1962602722
Name:RECORD, ALBERT L (EDD)
Entity type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:L
Last Name:RECORD
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 N 3RD AVE
Mailing Address - Street 2:SUITE #40
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-2429
Mailing Address - Country:US
Mailing Address - Phone:732-246-7211
Mailing Address - Fax:
Practice Address - Street 1:24 N 3RD AVE
Practice Address - Street 2:SUITE #40
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-2429
Practice Address - Country:US
Practice Address - Phone:732-246-7211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100219900103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ400708Medicare PIN