Healthcare Provider Details

I. General information

NPI: 1841549128
Provider Name (Legal Business Name): BENJAMIN ZVI GRYSMAN PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2012
Last Update Date: 02/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14108 JEWEL AVE
FLUSHING NY
11367-1618
US

IV. Provider business mailing address

14108 JEWEL AVE
FLUSHING NY
11367-1618
US

V. Phone/Fax

Practice location:
  • Phone: 347-815-4228
  • Fax: 347-402-8186
Mailing address:
  • Phone: 347-815-4228
  • Fax: 347-402-8186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number019732
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: