Provider Demographics
NPI:1619517430
Name:ELYSE KUPPERMAN CHAIFETZ, PH.D. PSYCHOLOGIST PLLC
Entity Type:Organization
Organization Name:ELYSE KUPPERMAN CHAIFETZ, PH.D. PSYCHOLOGIST PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELYSE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAIFETZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:917-473-3086
Mailing Address - Street 1:16 E 41ST ST STE 5E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-6217
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16 E 41ST ST STE 5E
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-6217
Practice Address - Country:US
Practice Address - Phone:917-473-3086
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1780018481OtherELYSE CHAIFETZ
1184074866OtherILANA ROSENBERG