Provider Demographics
NPI:1447235833
Name:MED-PSYCH SERVICE
Entity Type:Organization
Organization Name:MED-PSYCH SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMAD
Authorized Official - Middle Name:E
Authorized Official - Last Name:NAMIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-202-4949
Mailing Address - Street 1:43 HIGH POINT CIR
Mailing Address - Street 2:
Mailing Address - City:RYE BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:10573-1092
Mailing Address - Country:US
Mailing Address - Phone:914-202-4949
Mailing Address - Fax:
Practice Address - Street 1:ONE GATE WAY PLAZA
Practice Address - Street 2:3RD FLOOR
Practice Address - City:PORT CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10573
Practice Address - Country:US
Practice Address - Phone:914-202-4949
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209565261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02243456Medicaid
NY02243456Medicaid