Provider Demographics
NPI:1467619478
Name:SOLOMON, JEFFRY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JEFFRY
Middle Name:
Last Name:SOLOMON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 W 81ST ST
Mailing Address - Street 2:3A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-5808
Mailing Address - Country:US
Mailing Address - Phone:917-399-6907
Mailing Address - Fax:
Practice Address - Street 1:219 W 81ST ST
Practice Address - Street 2:3A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-5808
Practice Address - Country:US
Practice Address - Phone:917-399-6907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017590-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist