Provider Demographics
NPI:1437741824
Name:AMERICAN INSTITUTE OF TELEPSYCHIATRY LLC
Entity type:Organization
Organization Name:AMERICAN INSTITUTE OF TELEPSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NASREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAZACK-MALIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-276-8526
Mailing Address - Street 1:1280 LEXINGTON AVE FRNT 2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-2136
Mailing Address - Country:US
Mailing Address - Phone:321-276-8526
Mailing Address - Fax:
Practice Address - Street 1:1280 LEXINGTON AVE FRNT 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-2136
Practice Address - Country:US
Practice Address - Phone:321-246-8526
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-07
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty