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General NPI Number Information
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NPI Number | 1720906878
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Entity Type | Organization
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Legal Business Name | CORE SPRING DIAGNOSTICS W.I. S.C
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Dates
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Enumeration Date | 07/07/2026
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Last Update Date | 07/07/2026
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Provider Practice Location Address
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Address Line | 10625 W NORTH AVE STE LL1
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City | WAUWATOSA
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State | WI
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Zip | 53226-2330
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Country | US
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Telephone | 414-387-2100
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Fax | 414-387-2102
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Provider Business Mailing Address
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Address Line | 10625 W NORTH AVE STE LL1
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City | WAUWATOSA
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State | WI
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Zip | 53226-2330
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Country | US
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Telephone | 414-387-2100
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Fax | 414-387-2102
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Authorized Official
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Title or Position | OFFICER
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Name | JACOB DOV
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Credential |
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Telephone | 516-592-3079
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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