Healthcare Provider Details

I. General information

NPI: 1871930263
Provider Name (Legal Business Name): JUSTYNA ZAPOLSKA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2013
Last Update Date: 08/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 5TH AVE RM 1107
NEW YORK NY
10011-8017
US

IV. Provider business mailing address

80 5TH AVE RM 1107
NEW YORK NY
10011-8017
US

V. Phone/Fax

Practice location:
  • Phone: 917-579-6205
  • Fax:
Mailing address:
  • Phone: 917-579-6205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number019764
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: