Basic Information
| Provider Information | |||||||||
| NPI: | 1487958559 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INTERFAITH PSYCHIATRY SERVICES, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1545 ATLANTIC AVENUE | ||||||||
| Address2: | FACULTY PRACTICE | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186134708 | ||||||||
| FaxNumber: | 7186134101 | ||||||||
| Practice Location | |||||||||
| Address1: | 1545 ATLANTIC AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112131122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186134000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2011 | ||||||||
| LastUpdateDate: | 02/13/2020 | ||||||||
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| AuthorizedOfficialLastName: | HERSHBERGER | ||||||||
| AuthorizedOfficialFirstName: | JASON | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | CHAIRMAN / P.C. PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7186134969 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 02/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.