Basic Information
| Provider Information | |||||||||
| NPI: | 1679874747 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PHILIP | ||||||||
| FirstName: | BIJU | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 50 TODD CT | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTN STA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117464224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189635885 | ||||||||
| FaxNumber: | 7186303060 | ||||||||
| Practice Location | |||||||||
| Address1: | 760 BROADWAY | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112065317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189638148 | ||||||||
| FaxNumber: | 7186303060 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2010 | ||||||||
| LastUpdateDate: | 11/05/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 069503-1 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.