Provider Demographics
NPI:1053342931
Name:TANZER, ADAM (PHD)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:TANZER
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 1:301 OXFORD VALLEY RD STE 603A
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-7712
Mailing Address - Country:US
Mailing Address - Phone:215-687-7899
Mailing Address - Fax:
Practice Address - Street 1:301 OXFORD VALLEY RD STE 603A
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-7712
Practice Address - Country:US
Practice Address - Phone:215-687-7899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS015339103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPS015339OtherLICENSE NUMBER
PAPS015339OtherLICENSE NUMBER