Provider Demographics
NPI:1538150602
Name:MAYER, ELIEZER ROBERT (PSYD)
Entity type:Individual
Prefix:DR
First Name:ELIEZER
Middle Name:ROBERT
Last Name:MAYER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 W 9TH ST
Mailing Address - Street 2:SUITE 4B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-8971
Mailing Address - Country:US
Mailing Address - Phone:212-242-2219
Mailing Address - Fax:212-242-2219
Practice Address - Street 1:26 W 9TH ST
Practice Address - Street 2:SUITE 4B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8971
Practice Address - Country:US
Practice Address - Phone:212-242-2219
Practice Address - Fax:212-242-2219
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009386103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
V68181Medicare ID - Type Unspecified