Active NPI
Jennifer Wallach, PSYD
- Clinical Psychologist
- Teaneck, NJ
National Provider Identifier
1720228166
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 4796
- Practice address
- 705 Cedar LN FL 1
Teaneck, NJ 07666-1702 - Phone
- (646) 239-8032
- NPI assigned
- Feb 25, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 018153 | NY | |
| Clinical Psychologist | 103TC0700X | 4796 | NJ | Primary |
Addresses
Primary practice location
705 Cedar LN FL 1
Teaneck, NJ 07666-1702
Mailing address
705 Cedar LN FL 1
Teaneck, NJ 07666-1702
Phone (646) 239-8032
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4796 | NJ | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1235520000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1508716800000",
"number": "1720228166",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "705 CEDAR LN FL 1",
"city": "TEANECK",
"state": "NJ",
"postal_code": "076661702",
"telephone_number": "646-239-8032"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "705 CEDAR LN FL 1",
"city": "TEANECK",
"state": "NJ",
"postal_code": "076661702",
"telephone_number": "646-239-8032"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACH",
"first_name": "JENNIFER",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-02-25",
"last_updated": "2017-10-23",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "018153",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NJ",
"license": "4796",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Teaneck, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.