Provider Demographics
NPI:1356984173
Name:DR. DITZELL PSYCHIATRY, PLLC
Entity type:Organization
Organization Name:DR. DITZELL PSYCHIATRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:S
Authorized Official - Last Name:DITZELL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:917-612-0483
Mailing Address - Street 1:576 5TH AVE STE 805
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-4826
Mailing Address - Country:US
Mailing Address - Phone:917-842-5337
Mailing Address - Fax:917-591-7834
Practice Address - Street 1:576 5TH AVE STE 805
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-4826
Practice Address - Country:US
Practice Address - Phone:917-842-5337
Practice Address - Fax:917-591-7834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-24
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty