Provider Demographics
NPI:1720117096
Name:HUNZIKER, JILL EVAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:EVAN
Last Name:HUNZIKER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 BEACH 149TH ST
Mailing Address - Street 2:
Mailing Address - City:NEPONSIT
Mailing Address - State:NY
Mailing Address - Zip Code:11694-1022
Mailing Address - Country:US
Mailing Address - Phone:718-634-3774
Mailing Address - Fax:718-634-5047
Practice Address - Street 1:226 7TH ST
Practice Address - Street 2:SUITE 307
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-5723
Practice Address - Country:US
Practice Address - Phone:516-746-6466
Practice Address - Fax:718-634-5047
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012888-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical