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General NPI Number Information
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NPI Number | 1376078030
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Entity Type | Individual
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Provider Name | DAVID SUKIENNIK PSYD
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Gender | Male
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Dates
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Enumeration Date | 05/01/2017
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Last Update Date | 04/25/2023
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Provider Practice Location Address
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Address Line | 1 PARK AVE FL 7
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City | NEW YORK
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State | NY
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Zip | 10016-5818
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Country | US
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Telephone | 646-754-5197
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Fax |
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Provider Business Mailing Address
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Address Line | 175 W 72ND ST APT 6G
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City | NEW YORK
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State | NY
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Zip | 10023-3209
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Country | US
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Telephone | 402-689-0725
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 023688
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 023688
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License Number State | NY
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