Healthcare Provider Details

I. General information

NPI: 1215031844
Provider Name (Legal Business Name): JAKOW BIELSKI PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1358 56 STREET
BROOKLYN NY
11219
US

IV. Provider business mailing address

741 SHERWOOD STREET
NORTH WOODMERE NY
11581-3610
US

V. Phone/Fax

Practice location:
  • Phone: 718-851-7100
  • Fax: 718-438-2099
Mailing address:
  • Phone: 516-791-1299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number009113-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: