Provider Demographics
NPI:1619461258
Name:GAVRIEL REISNER PHD LP
Entity Type:Organization
Organization Name:GAVRIEL REISNER PHD LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GAVRIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:REISNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-969-9085
Mailing Address - Street 1:55 W END AVE APT S15I
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-7850
Mailing Address - Country:US
Mailing Address - Phone:212-969-9085
Mailing Address - Fax:
Practice Address - Street 1:55 W END AVE APT S15I
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-7850
Practice Address - Country:US
Practice Address - Phone:212-969-9085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-18
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalystGroup - Single Specialty