1053552430 NPI number — AGAPE PSYCHOLOGICAL SERVICES, P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053552430 NPI number — AGAPE PSYCHOLOGICAL SERVICES, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AGAPE PSYCHOLOGICAL SERVICES, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053552430
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/16/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
142 MINEOLA AVE
Provider Second Line Business Mailing Address:
SUITE 2H
Provider Business Mailing Address City Name:
ROSLYN HEIGHTS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11577-2056
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-621-5030
Provider Business Mailing Address Fax Number:
516-621-5393

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
142 MINEOLA AVE
Provider Second Line Business Practice Location Address:
SUITE 2H
Provider Business Practice Location Address City Name:
ROSLYN HEIGHTS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11577-2056
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-621-5030
Provider Business Practice Location Address Fax Number:
516-621-5393
Provider Enumeration Date:
03/16/2009

Additional Information

Authorized Official

Authorized Official Last Name:
CHIN
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
516-621-5030

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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