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General NPI Number Information
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NPI Number | 1518404417
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Entity Type | Organization
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Legal Business Name | ES PSYCHIATRIC P.C.
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Dates
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Enumeration Date | 01/30/2017
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Last Update Date | 01/30/2017
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Provider Practice Location Address
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Address Line | 99 HUDSON ST 5TH FLOOR, OFFICE 501
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City | NEW YORK
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State | NY
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Zip | 10013-2815
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Country | US
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Telephone | 646-301-2578
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Fax |
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Provider Business Mailing Address
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Address Line | 725 RIVER RD SUITE 32-79
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City | EDGEWATER
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State | NJ
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Zip | 07020-1171
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | EDWARD SHALTS
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Credential | MD
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Telephone | 646-301-2578
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | F401988
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 209237
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License Number State | NY
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