Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
DR. ELI MICHAEL SIMONG FORMAN, PHD
ActiveMarriage & Family Therapist · LEONIA, NJ
Registration Details
- NPI Number
- 1033218714
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Sep 21, 2006 (19.59097392334 yrs)
- Last Updated
- Sep 11, 2025
- Licenses
-
5688633 (NY)0019 (MD)M038 (MD)MFC13681 (CA)37F100059900 (NJ)
Practice Information
- Address
-
431 PARK AVENUELEONIA, NJ, 076051219Browse NJ providers · Browse ZIP 07605
- Phone
- 2015927388
- Fax
- 2015926301
- Primary Specialty
-
Marriage & Family Therapist
106H00000X
- Additional Specialty
- Professional Counselor
- Additional Specialty
- Marriage & Family Therapist
- Additional Specialty
- Marriage & Family Therapist
- Additional Specialty
- Marriage & Family Therapist
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.