Provider Demographics
NPI:1881775567
Name:COLYAR, JOHN J JR (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:COLYAR
Suffix:JR
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 1:109 W MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:MERCHANTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08109-2038
Mailing Address - Country:US
Mailing Address - Phone:856-661-0324
Mailing Address - Fax:856-488-9027
Practice Address - Street 1:109 W MAPLE AVE
Practice Address - Street 2:
Practice Address - City:MERCHANTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08109-2038
Practice Address - Country:US
Practice Address - Phone:856-661-0324
Practice Address - Fax:856-488-9027
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSI02758103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5157005Medicaid
NJ5157005Medicaid