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General NPI Number Information
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NPI Number | 1891192852
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Entity Type | Individual
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Provider Name | OLGA MAGIDINA NIKELSHPUR PH.D,
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Gender | Female
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Dates
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Enumeration Date | 11/19/2014
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Last Update Date | 01/24/2020
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Provider Practice Location Address
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Address Line | 360 ESSEX ST STE 303
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City | HACKENSACK
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State | NJ
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Zip | 07601-8566
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Country | US
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Telephone | 917-769-6557
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Fax |
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Provider Business Mailing Address
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Address Line | 360 ESSEX ST STE 303
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City | HACKENSACK
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State | NJ
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Zip | 07601-8566
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Country | US
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Telephone | 917-769-6557
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 020815 -1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 35SI00622100
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License Number State | NJ
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