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General NPI Number Information
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NPI Number | 1992249098
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Entity Type | Organization
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Legal Business Name | BROOKLYN MINDS PSYCHIATRY, P.C.
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Dates
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Enumeration Date | 12/07/2016
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Last Update Date | 09/04/2024
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Provider Practice Location Address
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Address Line | 253 W 28TH ST
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City | NEW YORK
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State | NY
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Zip | 10001-5914
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Country | US
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Telephone | 929-296-1624
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Fax | 888-374-3251
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Provider Business Mailing Address
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Address Line | 253 W 28TH ST
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City | NEW YORK
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State | NY
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Zip | 10001-5914
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Country | US
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Telephone | 917-451-7018
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Fax | 888-374-3251
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Authorized Official
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Title or Position | OWNER
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Name | AMANDA ITZKOFF
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Credential |
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Telephone | 212-734-6621
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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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 | 2785171
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License Number State | NY
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