Provider Demographics
NPI:1598185852
Name:FIALKOV, EMMA DAWN (MSED)
Entity Type:Individual
Prefix:MS
First Name:EMMA
Middle Name:DAWN
Last Name:FIALKOV
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 W 30TH ST
Mailing Address - Street 2:9TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-4406
Mailing Address - Country:US
Mailing Address - Phone:161-746-2910
Mailing Address - Fax:212-967-4917
Practice Address - Street 1:7 W 30TH ST
Practice Address - Street 2:9TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-4406
Practice Address - Country:US
Practice Address - Phone:161-746-2910
Practice Address - Fax:212-967-4917
Is Sole Proprietor?:No
Enumeration Date:2014-04-24
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP92344101YM0800X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1285628552OtherAGENCIES NPI
NY00355940Medicaid