1396975538 NPI number — MRS. JUSTINE SUE ONDRICEK LCSW

Table of content: MRS. JUSTINE SUE ONDRICEK LCSW (NPI 1396975538)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396975538 NPI number — MRS. JUSTINE SUE ONDRICEK LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ONDRICEK
Provider First Name:
JUSTINE
Provider Middle Name:
SUE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HAJJAR
Provider Other First Name:
JUSTINE
Provider Other Middle Name:
SUE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1396975538
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/31/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
152 EAST 94TH STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10128-2510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-255-3258
Provider Business Mailing Address Fax Number:
212-256-0275

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
45 POPHAM RD,
Provider Second Line Business Practice Location Address:
SUITE 1F,
Provider Business Practice Location Address City Name:
SCARSDALE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10583
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-255-3258
Provider Business Practice Location Address Fax Number:
212-256-0275
Provider Enumeration Date:
07/22/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  R025106-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 13253P . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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