Provider Demographics
NPI:1336888064
Name:ROIZMAN, JASMINE MICHAL
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:MICHAL
Last Name:ROIZMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 UNION SQ S APT 22B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4193
Mailing Address - Country:US
Mailing Address - Phone:215-353-8690
Mailing Address - Fax:
Practice Address - Street 1:769 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-6803
Practice Address - Country:US
Practice Address - Phone:917-382-1478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-01
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health