| NPI | 1598781973 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROSTISLAV VILSHTEYN CEO 718-813-4556 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: NJ 051A267) |
| Additional Taxonomies | 103TA0700X Psychologist, Adult Development & Aging (Licence: NJ 051a267) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NJ 051a267) | |
| 103TC1900X Psychologist, Counseling (Licence: NJ 051A267) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NJ 051A267) | |
| 103T00000X Psychologist (Licence: NJ 051A267) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: NJ 051A267) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: NJ 051a267) | |
| 363L00000X Nurse Practitioner | |
| 363LC1500X Nurse Practitioner, Community Health | |
| 363LP2300X Nurse Practitioner, Primary Care | |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2020-08-22 |