Healthcare Provider Details

I. General information

NPI: 1336888064
Provider Name (Legal Business Name): JASMINE MICHAL ROIZMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2022
Last Update Date: 08/04/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

769 BROADWAY
NEW YORK NY
10003-6803
US

IV. Provider business mailing address

1 UNION SQ S APT 22B
NEW YORK NY
10003-4193
US

V. Phone/Fax

Practice location:
  • Phone: 917-382-1478
  • Fax:
Mailing address:
  • Phone: 215-353-8690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: