Healthcare Provider Details

I. General information

NPI: 1902734395
Provider Name (Legal Business Name): YEHUDA FOGEL PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 CLARKSON AVE
BROOKLYN NY
11203-2054
US

IV. Provider business mailing address

1266 PACIFIC ST APT 4B
BROOKLYN NY
11216-6248
US

V. Phone/Fax

Practice location:
  • Phone: 516-262-8535
  • Fax:
Mailing address:
  • Phone: 516-262-8535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number028205
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: