Provider Demographics
NPI:1902439987
Name:SULTAN, ALBERT JASON (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:JASON
Last Name:SULTAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 AVENUE V
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-4938
Mailing Address - Country:US
Mailing Address - Phone:732-977-1958
Mailing Address - Fax:
Practice Address - Street 1:792 CHIMNEY ROCK RD STE C
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08836-2271
Practice Address - Country:US
Practice Address - Phone:908-393-1533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00619000103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist