Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY05607 | NY |
Y | 103TC0700X | Clinical Psychologist | PSY05607 | NY |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PSY05607 | NY |
N | 103G00000X | Clinical Psychologist | PSY05607 | NY |
N | 103TC0700X | Clinical Psychologist | PSY05607 | NY |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PSY05607 | NY |
N | 103TF0200X | Forensic Psychologist | PSY05607 | NY |
N | 103TM1800X | Intellectual & Developmental Disabilities | PSY05607 | NY |
NPI | 1164548079 |
---|---|
Provider Name | Dr. Ezra Sion Gampel |
First Address | Staten Island, NY 10314-5079 |
Second Address | Staten Island, NY 10314-5079 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2007 |
Last Update Date | 15/11/2011 |