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General NPI Number Information
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NPI Number | 1316453509
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Entity Type | Organization
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Legal Business Name | FYRKLOVER MIND REFLECTION MEDICAL
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Dates
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Enumeration Date | 12/25/2017
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Last Update Date | 12/25/2017
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Provider Practice Location Address
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Address Line | 184 E 70TH ST
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City | NEW YORK
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State | NY
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Zip | 10021-5154
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Country | US
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Telephone | 347-857-0755
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Fax |
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Provider Business Mailing Address
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Address Line | 37 SHERMAN AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10301-2301
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Country | US
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Telephone | 347-857-0755
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JURAJ LUKAC
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Credential | MD
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Telephone | 347-857-0755
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 249039-1
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License Number State | NY
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