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General NPI Number Information
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NPI Number | 1760205157
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Entity Type | Individual
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Provider Name | EMMA JUN DISTLER
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Gender | Female
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Dates
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Enumeration Date | 11/04/2024
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 1199 PARK AVE STE 1V
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City | NEW YORK
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State | NY
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Zip | 10128-1711
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Country | US
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Telephone | 212-828-7473
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Fax |
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Provider Business Mailing Address
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Address Line | 334 W 71ST ST APT 6
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City | NEW YORK
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State | NY
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Zip | 10023-3559
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Country | US
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Telephone | 516-404-6743
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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