Healthcare Provider Details

I. General information

NPI: 1083183487
Provider Name (Legal Business Name): ELIJAH BELL PH. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2018
Last Update Date: 11/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1591 BRUCKNER BLVD APT 14D
BRONX NY
10472-6431
US

IV. Provider business mailing address

PO BOX 352
NANUET NY
10954-0352
US

V. Phone/Fax

Practice location:
  • Phone: 718-378-3540
  • Fax:
Mailing address:
  • Phone: 718-378-3540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number022996-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: