1891875225 NPI number — B&L COGNITIVE BEHAVIORAL PSYCHOLOGY PLLC

Table of content: (NPI 1891875225)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891875225 NPI number — B&L COGNITIVE BEHAVIORAL PSYCHOLOGY PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
B&L COGNITIVE BEHAVIORAL PSYCHOLOGY PLLC
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:
NEW YORK COGNITIVE THERAPY AND WELLNESS CENTER
Provider Other Organization Name Type Code:
3
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:
1891875225
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 MONTAUK HWY
Provider Second Line Business Mailing Address:
SUITE 112
Provider Business Mailing Address City Name:
WEST ISLIP
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11795-4429
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-321-7107
Provider Business Mailing Address Fax Number:
631-321-7108

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 MONTAUK HWY
Provider Second Line Business Practice Location Address:
SUITE 112
Provider Business Practice Location Address City Name:
WEST ISLIP
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11795-4429
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-327-7107
Provider Business Practice Location Address Fax Number:
631-321-7108
Provider Enumeration Date:
10/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LANCASTER
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
M
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
631-321-7107

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TC1900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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