1285768978 NPI number — LONG BEACH PSYCHOLOGICAL ASSOCIATES LLP

Table of content: (NPI 1285768978)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285768978 NPI number — LONG BEACH PSYCHOLOGICAL ASSOCIATES LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LONG BEACH PSYCHOLOGICAL ASSOCIATES LLP
Provider Last Name:
Provider First Name:
Provider Middle Name:
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Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
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NPI Number Information

NPI Number:
1285768978
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
32 BAY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST ATLANTIC BEACH
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11561-1002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-431-0453
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2-12 EAST PARK AVE
Provider Second Line Business Practice Location Address:
2ND FLOOR- SOMATIC WELLNESS
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11561
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-431-0453
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LEVY
Authorized Official First Name:
MAURICE
Authorized Official Middle Name:
Authorized Official Title or Position:
PSYCHOLOGIST
Authorized Official Telephone Number:
516-431-0453

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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