Active NPI
Evan Michael Kroll
- Clinical Child & Adolescent Psychologist
- Teaneck, NJ
National Provider Identifier
1881924967
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Child & Adolescent Psychologist
- License
- 4351
- Practice address
- 100 State St
Suite 2D
Teaneck, NJ 07666-5200 - Phone
- (201) 384-6667
- NPI assigned
- Jan 12, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Child & Adolescent Psychologist | 103TC2200X | 4351 | NJ | Primary |
Addresses
Primary practice location
100 State St
Suite 2D
Teaneck, NJ 07666-5200
Mailing address
100 State St
Suite 2D
Teaneck, NJ 07666-5200
Phone (201) 384-6667
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 |
|---|---|---|---|
| 4351 | NJ | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1263254400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1263254400000",
"number": "1881924967",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 STATE ST",
"address_2": "SUITE 2D",
"city": "TEANECK",
"state": "NJ",
"postal_code": "076665200",
"telephone_number": "201-384-6667"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 STATE ST",
"address_2": "SUITE 2D",
"city": "TEANECK",
"state": "NJ",
"postal_code": "076665200",
"telephone_number": "201-384-6667"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KROLL",
"first_name": "EVAN",
"middle_name": "MICHAEL",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-01-12",
"last_updated": "2010-01-12",
"status": "A"
},
"taxonomies": [
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "NJ",
"license": "4351",
"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 Jan 12, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.