Healthcare Provider Details

I. General information

NPI: 1811063225
Provider Name (Legal Business Name): STANFORD A GRIFFITH PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 01/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8786 188TH ST
JAMAICA NY
11423-1131
US

IV. Provider business mailing address

8786 188TH ST
JAMAICA NY
11423-1131
US

V. Phone/Fax

Practice location:
  • Phone: 718-526-2521
  • Fax: 718-883-6193
Mailing address:
  • Phone: 718-526-2521
  • Fax: 718-334-3432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number007974
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: