Provider Demographics
NPI:1700124633
Name:FAMILY CENTER FOR BIPOLAR DISORDER AT BETH ISRAEL MEDICAL CENTER
Entity Type:Organization
Organization Name:FAMILY CENTER FOR BIPOLAR DISORDER AT BETH ISRAEL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:
Authorized Official - Last Name:GALYNKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-420-2204
Mailing Address - Street 1:317 E 17TH ST
Mailing Address - Street 2:5TH FLOOR, SUITE 13
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-3804
Mailing Address - Country:US
Mailing Address - Phone:212-844-1742
Mailing Address - Fax:812-420-4332
Practice Address - Street 1:317 E 17TH ST
Practice Address - Street 2:5TH FLOOR, SUITE 13
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3804
Practice Address - Country:US
Practice Address - Phone:212-844-1742
Practice Address - Fax:812-420-4332
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BETH ISRAEL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019918103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty