Provider Demographics
NPI:1043248776
Name:PSYCHOLOGICAL HEALTH SERVICES P.C.
Entity Type:Organization
Organization Name:PSYCHOLOGICAL HEALTH SERVICES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:DURLOFSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:888-515-3834
Mailing Address - Street 1:PO BOX 68048
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07101-8085
Mailing Address - Country:US
Mailing Address - Phone:888-515-3834
Mailing Address - Fax:
Practice Address - Street 1:100 PARK AVE FL 16
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-5538
Practice Address - Country:US
Practice Address - Phone:888-515-3834
Practice Address - Fax:855-688-6746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013758103TC0700X
1041C0700X, 2084P0800X, 363A00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV5W761Medicare PIN
NY04764Medicare PIN