Provider Demographics
NPI:1518404417
Name:ES PSYCHIATRIC P.C.
Entity type:Organization
Organization Name:ES PSYCHIATRIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SHALTS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-301-2578
Mailing Address - Street 1:725 RIVER RD
Mailing Address - Street 2:SUITE 32-79
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-1171
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:99 HUDSON ST
Practice Address - Street 2:5TH FLOOR, OFFICE 501
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-2815
Practice Address - Country:US
Practice Address - Phone:646-301-2578
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-30
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF401988363LP0808X
NY2092372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty