Provider Demographics
NPI:1396565727
Name:JELTOVA PSYCHOLOGICAL SERVICES PLLC
Entity type:Organization
Organization Name:JELTOVA PSYCHOLOGICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:IDA
Authorized Official - Middle Name:
Authorized Official - Last Name:JELTOVA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:201-757-0600
Mailing Address - Street 1:15 GLORIA DR
Mailing Address - Street 2:
Mailing Address - City:ALLENDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07401-1335
Mailing Address - Country:US
Mailing Address - Phone:201-757-0600
Mailing Address - Fax:
Practice Address - Street 1:116 CLINTON ST # 4
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4204
Practice Address - Country:US
Practice Address - Phone:201-757-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-11
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health