Provider Demographics
NPI:1467765156
Name:PULEWITZ, MATTHEW (PSYD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:PULEWITZ
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1955 MERRICK RD STE 201
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-4635
Mailing Address - Country:US
Mailing Address - Phone:516-379-7009
Mailing Address - Fax:
Practice Address - Street 1:1955 MERRICK RD STE 201
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-4635
Practice Address - Country:US
Practice Address - Phone:516-379-7009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-22
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013917103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical