Provider Demographics
NPI:1104221084
Name:RECUPERATIVE PSYCHIATRIC SERVICES OF QUEENS PLLC
Entity Type:Organization
Organization Name:RECUPERATIVE PSYCHIATRIC SERVICES OF QUEENS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEINSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-732-9646
Mailing Address - Street 1:163-03 HORACE HARDING EXPREWSSWAY
Mailing Address - Street 2:SUITE 301
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365
Mailing Address - Country:US
Mailing Address - Phone:347-732-9646
Mailing Address - Fax:
Practice Address - Street 1:163-03 HORACE HARDING EXPREWSSWAY
Practice Address - Street 2:SUITE 301
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365
Practice Address - Country:US
Practice Address - Phone:347-732-9646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20384612084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01733802Medicaid
NY02891Medicare PIN