Provider Demographics
NPI:1588840201
Name:JEPHTHA TAUSIG-EDWARDS, PHD PLLC
Entity type:Organization
Organization Name:JEPHTHA TAUSIG-EDWARDS, PHD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEPHTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAUSIG-EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:212-595-9348
Mailing Address - Street 1:295 CENTRAL PARK W
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-3008
Mailing Address - Country:US
Mailing Address - Phone:212-595-9348
Mailing Address - Fax:
Practice Address - Street 1:295 CENTRAL PARK W
Practice Address - Street 2:SUITE 2
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3008
Practice Address - Country:US
Practice Address - Phone:212-595-9348
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016753-1261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health