| DOCUMENT |
DETAIL |
EXPIRATION |
| National Board of Medical Examiners |
Certificate 84740, issued 1965 |
|
| New York State Medical License |
Number 096798, issued 1966 |
31JAN2002 |
| Virginia State Medical License |
Number 20416, issued 1969 |
(Inactive) |
| New Jersey State Medical License |
Number MA026333, issued 1972 |
30JUN2003 |
| American Board of Psychiatry and Neurology (Psychiatry) |
Certificate 12001, issued 1972 |
|
| Medicaid |
UPIN C59768 |
|
| Medicaid Provider |
Service Number 0827207 |
|
| Medicare |
Number PU460906 |
|
| Malpractice Insurance Policy |
Number PS00012803
Princeton Insurance Company
$1/$3,000,000 |
20MAY2002 |
| DEA Registration |
Number AP5469211 for schedules 2, 2N, 3, 3N, 4, 5 |
31MAR2002 |
| NJ CDS Registration |
Number D014073, for schedules 2, 3, 4, 5 |
31AUG2002 |