Provider Demographics
NPI:1003571639
Name:ARMSTRONG, JEREL AULSTROUPT
Entity type:Individual
Prefix:MR
First Name:JEREL
Middle Name:AULSTROUPT
Last Name:ARMSTRONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3205 WICKHAM AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-3122
Mailing Address - Country:US
Mailing Address - Phone:718-379-9059
Mailing Address - Fax:
Practice Address - Street 1:1053 SAW MILL RIVER RD STE 101
Practice Address - Street 2:
Practice Address - City:ARDSLEY
Practice Address - State:NY
Practice Address - Zip Code:10502-1047
Practice Address - Country:US
Practice Address - Phone:212-732-5427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1208179103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst