Healthcare Provider Details

I. General information

NPI: 1780891721
Provider Name (Legal Business Name): WILLIAM J HURST PHD, LP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 AMITY ST
BROOKLYN NY
11201-6108
US

IV. Provider business mailing address

149 AMITY ST
BROOKLYN NY
11201-6108
US

V. Phone/Fax

Practice location:
  • Phone: 718-858-4664
  • Fax: 718-858-3633
Mailing address:
  • Phone: 718-858-4664
  • Fax: 718-858-3633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number000078
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: