Provider Demographics
NPI:1154612653
Name:DR. JUDITH SUSAN GEIZHALS PHD
Entity type:Organization
Organization Name:DR. JUDITH SUSAN GEIZHALS PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:GEIZHALS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:516-883-6282
Mailing Address - Street 1:114 MIDDLE NECK RD
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-1933
Mailing Address - Country:US
Mailing Address - Phone:516-883-6282
Mailing Address - Fax:
Practice Address - Street 1:114 MIDDLE NECK RD
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-1933
Practice Address - Country:US
Practice Address - Phone:516-883-6282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-02
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0069611103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty