Healthcare Provider Details

I. General information

NPI: 1043083389
Provider Name (Legal Business Name): DALIA GEFEN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2023
Last Update Date: 10/30/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1517 BROADWAY
HEWLETT NY
11557-1427
US

IV. Provider business mailing address

1517 BROADWAY
HEWLETT NY
11557-1427
US

V. Phone/Fax

Practice location:
  • Phone: 516-639-3676
  • Fax:
Mailing address:
  • Phone: 516-639-3676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number019826
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: