Provider Demographics
NPI:1932425154
Name:SZPITALAK, VIJAYTA CHOUDHARY (EDM, MA)
Entity Type:Individual
Prefix:MRS
First Name:VIJAYTA
Middle Name:CHOUDHARY
Last Name:SZPITALAK
Suffix:
Gender:F
Credentials:EDM, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 RIVER TER
Mailing Address - Street 2:7A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10282-1241
Mailing Address - Country:US
Mailing Address - Phone:646-241-6569
Mailing Address - Fax:
Practice Address - Street 1:2 RIVER TER
Practice Address - Street 2:7A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10282-1241
Practice Address - Country:US
Practice Address - Phone:646-535-4325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-13
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP73164101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01082397Medicaid
NYWX0561Medicare UPIN