Provider Demographics
NPI:1114233483
Name:JUDITH S. GEIZHALS, PH.D.,P.C.
Entity Type:Organization
Organization Name:JUDITH S. GEIZHALS, PH.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:S
Authorized Official - Last Name:GEIZHALS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:516-883-6282
Mailing Address - Street 1:114 MIDDLE NECK RD
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-1933
Mailing Address - Country:US
Mailing Address - Phone:516-883-6282
Mailing Address - Fax:516-883-6282
Practice Address - Street 1:114 MIDDLE NECK RD
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-1933
Practice Address - Country:US
Practice Address - Phone:516-883-6282
Practice Address - Fax:516-883-6282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006961-1261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)