Provider Demographics
NPI:1255774766
Name:DR. JM DA SILVA PSYCHOLOGIST PC
Entity type:Organization
Organization Name:DR. JM DA SILVA PSYCHOLOGIST PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JURACI
Authorized Official - Middle Name:M
Authorized Official - Last Name:DA SILVA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:917-903-5067
Mailing Address - Street 1:68 LAIGHT ST APT 7
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-2049
Mailing Address - Country:US
Mailing Address - Phone:917-903-5067
Mailing Address - Fax:212-226-7380
Practice Address - Street 1:68 LAIGHT ST APT 7
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-2049
Practice Address - Country:US
Practice Address - Phone:917-903-5067
Practice Address - Fax:212-226-7380
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR. JM DA SILVA PSYCHOLOGIST PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-15
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018633-1261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS18633-8WOtherWORKER'S COMPENSATION, NON-FAULT