MEDICARE: DR. JAKOW BIELSKI PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	009113-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	009113-1	OTHER	NY	NYS LICENSE NUMBER

General Provider Information

NPI Number	:	1215031844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAKOW BIELSKI PHD

Provider Business Mailing Address
First Line	:	741 SHERWOOD STREET
Second Line	:
City	:	NORTH WOODMERE
State	:	NY
Zip	:	11581-3610
Country	:	US
Telephone Number	:	516-791-1299
Fax Number	:

Provider Business Practice Location Address
First Line	:	1358 56 STREET
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219
Country	:	US
Telephone Number	:	718-851-7100
Fax Number	:	718-438-2099

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2006
Last Update Date	:	07/08/2007

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