Provider Demographics
NPI:1255667465
Name:HERITAGE PSYCHIATRY SERVICES, P.C.
Entity Type:Organization
Organization Name:HERITAGE PSYCHIATRY SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:TRACHTENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-359-1096
Mailing Address - Street 1:8 INDEPENDENCE DR
Mailing Address - Street 2:
Mailing Address - City:MANHASSET HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11040-1023
Mailing Address - Country:US
Mailing Address - Phone:917-359-1096
Mailing Address - Fax:516-869-0560
Practice Address - Street 1:8 INDEPENDENCE DR
Practice Address - Street 2:
Practice Address - City:MANHASSET HILLS
Practice Address - State:NY
Practice Address - Zip Code:11040-1023
Practice Address - Country:US
Practice Address - Phone:917-359-1096
Practice Address - Fax:516-869-0560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-22
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1963422084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03162645Medicaid
NY03162645Medicaid