Individual
DR. ELI MICHAEL SIMONG FORMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
431 PARK AVENUE, LEONIA, NJ 07605-1219
(201) 592-7388
(201) 592-6301
Mailing address
431 PARK AVENUE, LEONIA, NJ 07605-1219
(201) 592-7388
(201) 592-6301
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
5688633
NY
101YP2500X
Professional Counselor
0019
MD
106H00000X
Marriage & Family Therapist
Primary
37F100059900
NJ
106H00000X
Marriage & Family Therapist
M038
MD
106H00000X
Marriage & Family Therapist
MFC13681
CA
Other
Enumeration date
09/21/2006
Last updated
09/11/2025
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