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General NPI Number Information
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NPI Number | 1518581206
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Entity Type | Organization
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Legal Business Name | FULL GESTALT
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Dates
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Enumeration Date | 05/29/2020
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Last Update Date | 05/29/2020
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Provider Practice Location Address
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Address Line | 5 W 86TH ST APT 1B
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City | NEW YORK
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State | NY
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Zip | 10024-3663
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Country | US
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Telephone | 917-215-1629
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Fax |
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Provider Business Mailing Address
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Address Line | 5 W 86TH ST APT 1B
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City | NEW YORK
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State | NY
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Zip | 10024-3663
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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 | CONSULTANT
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Name | MICHAEL MEIKSON
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Credential |
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Telephone | 917-842-8765
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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