Provider Demographics
NPI:1407261811
Name:NORTH FORK NEUROPSYCHOLOGY
Entity Type:Organization
Organization Name:NORTH FORK NEUROPSYCHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:CELINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PAILLOT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:631-512-2232
Mailing Address - Street 1:633 ROANOKE AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2727
Mailing Address - Country:US
Mailing Address - Phone:631-512-2232
Mailing Address - Fax:480-247-4658
Practice Address - Street 1:633 ROANOKE AVE
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2727
Practice Address - Country:US
Practice Address - Phone:631-512-2232
Practice Address - Fax:480-247-4658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019026-1261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03319817Medicaid
NY03319817Medicaid