Healthcare Provider Details

I. General information

NPI: 1972306280
Provider Name (Legal Business Name): MARYELLEN HURWITZ PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14415 68TH RD
FLUSHING NY
11367-1330
US

IV. Provider business mailing address

2719 HOLLYWOOD BLVD STE 5469
HOLLYWOOD FL
33020-4821
US

V. Phone/Fax

Practice location:
  • Phone: 973-264-0023
  • Fax: 973-264-0022
Mailing address:
  • Phone: 973-264-0023
  • Fax: 973-264-0022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number014226
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: