Healthcare Provider Details

I. General information

NPI: 1437741824
Provider Name (Legal Business Name): AMERICAN INSTITUTE OF TELEPSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2021
Last Update Date: 07/30/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1280 LEXINGTON AVE FRNT 2
NEW YORK NY
10028-2136
US

IV. Provider business mailing address

1280 LEXINGTON AVE FRNT 2
NEW YORK NY
10028-2136
US

V. Phone/Fax

Practice location:
  • Phone: 321-246-8526
  • Fax:
Mailing address:
  • Phone: 321-276-8526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: NASREEN RAZACK-MALIK
Title or Position: OWNER
Credential: MD
Phone: 321-276-8526