Provider Demographics
NPI:1477965978
Name:NEW YORK PSYCHOLOGICAL WELLNESS, PC
Entity Type:Organization
Organization Name:NEW YORK PSYCHOLOGICAL WELLNESS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:MEYERS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:718-225-5505
Mailing Address - Street 1:4640 SPRINGFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-3517
Mailing Address - Country:US
Mailing Address - Phone:718-225-5505
Mailing Address - Fax:
Practice Address - Street 1:4640 SPRINGFIELD BLVD
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-3517
Practice Address - Country:US
Practice Address - Phone:718-225-5505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018595103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty