Provider Demographics
NPI:1972019578
Name:ROYZMAN, STANISLAV (PSYD)
Entity Type:Individual
Prefix:DR
First Name:STANISLAV
Middle Name:
Last Name:ROYZMAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 BASCOM PL
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-4204
Mailing Address - Country:US
Mailing Address - Phone:929-253-1969
Mailing Address - Fax:
Practice Address - Street 1:236 5TH AVE STE 411
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-7606
Practice Address - Country:US
Practice Address - Phone:718-675-4710
Practice Address - Fax:718-675-4710
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-18
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022181103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical