Healthcare Provider Details

I. General information

NPI: 1790860567
Provider Name (Legal Business Name): STANISLAV GEFTER CASE ASSOCIATE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3312 SURF AVE
BROOKLYN NY
11224-1406
US

IV. Provider business mailing address

2820 W 32ND ST APT.# 5D
BROOKLYN NY
11224-1841
US

V. Phone/Fax

Practice location:
  • Phone: 718-372-3300
  • Fax:
Mailing address:
  • Phone: 718-769-5186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: