Provider Demographics
NPI:1235205360
Name:ADC PSYCHOLOGICAL SERVICES PLLC
Entity Type:Organization
Organization Name:ADC PSYCHOLOGICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:SALAMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-596-0073
Mailing Address - Street 1:1728 BROADWAY
Mailing Address - Street 2:SUITE # 1
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557-1630
Mailing Address - Country:US
Mailing Address - Phone:516-596-0073
Mailing Address - Fax:516-599-5698
Practice Address - Street 1:1728 BROADWAY
Practice Address - Street 2:SUITE # 1
Practice Address - City:HEWLETT
Practice Address - State:NY
Practice Address - Zip Code:11557-1630
Practice Address - Country:US
Practice Address - Phone:516-596-0073
Practice Address - Fax:516-599-5698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010847103TA0700X
NY007842103TC0700X
NY010263103TC0700X
NYR03181311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & AgingGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN4C331Medicare ID - Type UnspecifiedSOCIAL WORKER
NYV25631Medicare ID - Type UnspecifiedPSYCHOLOGIST
NYV6B321Medicare ID - Type UnspecifiedPSYCHOLOGIST
NYV66061Medicare ID - Type UnspecifiedPSYCHOLOGIST