Provider Demographics
NPI:1326416199
Name:NEW LIFE PSYCHIATRY COUNSELING SERVICE
Entity Type:Organization
Organization Name:NEW LIFE PSYCHIATRY COUNSELING SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:IMRAN
Authorized Official - Middle Name:AZIZ
Authorized Official - Last Name:SHAIKH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-403-6271
Mailing Address - Street 1:7127 FRESH POND RD
Mailing Address - Street 2:FIRST FLOOR RIGHT
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-5918
Mailing Address - Country:US
Mailing Address - Phone:718-381-2829
Mailing Address - Fax:718-381-2819
Practice Address - Street 1:7127 FRESH POND RD
Practice Address - Street 2:FIRST FLOOR RIGHT
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-5918
Practice Address - Country:US
Practice Address - Phone:718-381-2829
Practice Address - Fax:718-381-2819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2649082084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty