Provider Demographics
NPI:1215031844
Name:BIELSKI, JAKOW (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAKOW
Middle Name:
Last Name:BIELSKI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 SHERWOOD STREET
Mailing Address - Street 2:
Mailing Address - City:NORTH WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11581-3610
Mailing Address - Country:US
Mailing Address - Phone:516-791-1299
Mailing Address - Fax:
Practice Address - Street 1:1358 56 STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219
Practice Address - Country:US
Practice Address - Phone:718-851-7100
Practice Address - Fax:718-438-2099
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009113-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY009113-1OtherNYS LICENSE NUMBER