Healthcare Provider Details

I. General information

NPI: 1225953318
Provider Name (Legal Business Name): GHEORG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1435 YELLOWHEART WAY
HOLLYWOOD FL
33019-4859
US

IV. Provider business mailing address

8 THE GRN STE B
DOVER DE
19901-3618
US

V. Phone/Fax

Practice location:
  • Phone: 516-529-0417
  • Fax:
Mailing address:
  • Phone: 516-529-0417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DANA L. KLEIN
Title or Position: CO-FOUNDER/CEO
Credential:
Phone: 516-529-0417