Basic Information
| Provider Information | |||||||||
| NPI: | 1508912296 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GAJSTUT | ||||||||
| FirstName: | SANDY | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8956 162ND ST | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | JAMAICA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114325072 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182978000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8956 162ND ST | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | JAMAICA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114325072 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182978000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2007 | ||||||||
| LastUpdateDate: | 01/28/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 071795 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.