Basic Information
Provider Information | |||||||||
NPI: | 1053348862 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ESSIF | ||||||||
FirstName: | GEORGE | ||||||||
MiddleName: | J | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: | JR. | ||||||||
Credential: | MS | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | ESSIF | ||||||||
OtherFirstName: | JAY | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MS | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | 1803 MOUNT ROSE AVE | ||||||||
Address2: | SUITE B3 | ||||||||
City: | YORK | ||||||||
State: | PA | ||||||||
PostalCode: | 174033026 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7178511405 | ||||||||
FaxNumber: | 7178516349 | ||||||||
Practice Location | |||||||||
Address1: | 3550 CONCORD RD | ||||||||
Address2: |   | ||||||||
City: | YORK | ||||||||
State: | PA | ||||||||
PostalCode: | 174028626 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7178516340 | ||||||||
FaxNumber: | 7178516349 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/27/2006 | ||||||||
LastUpdateDate: | 06/13/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | PS002814L | PA | Y |   | Behavioral Health & Social Service Providers | Psychologist |   |
ID Information
ID | Type | State | Issuer | Description | 576315000 | 01 | PA | MAGELLAN | OTHER | 2144104 | 01 | PA | MAMSI | OTHER | 64758001 | 01 | PA | BC/BS OF MD CARE FIRST | OTHER | 2250054 | 01 | PA | CIGNA BEHAVIORAL HEALTH | OTHER | 279799 | 01 | PA | VALUE OPTIONS | OTHER | 511549 | 01 | PA | PA BLUE SHIELD | OTHER | 50053665 | 01 | PA | CAPITAL BLUE CROSS | OTHER |