Provider Demographics
NPI:1760657985
Name:JAY S. KWAWER, PH.D., P.C.
Entity Type:Organization
Organization Name:JAY S. KWAWER, PH.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:S
Authorized Official - Last Name:KWAWER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:212-799-3083
Mailing Address - Street 1:490 W END AVE
Mailing Address - Street 2:SUITE 1-E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-4330
Mailing Address - Country:US
Mailing Address - Phone:212-799-3083
Mailing Address - Fax:815-366-9081
Practice Address - Street 1:490 W END AVE
Practice Address - Street 2:SUITE 1-E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-4329
Practice Address - Country:US
Practice Address - Phone:212-799-3083
Practice Address - Fax:815-366-9081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4237103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty