Provider Demographics
NPI:1578075040
Name:MICHAEL A HERSHIPS PSYCHOLOGIST, PC
Entity Type:Organization
Organization Name:MICHAEL A HERSHIPS PSYCHOLOGIST, PC
Other - Org Name:MICHAEL HERSHIPS, PHD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HERSHIPS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:631-361-9338
Mailing Address - Street 1:222 E MIDDLE COUNTRY RD STE 210
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2814
Mailing Address - Country:US
Mailing Address - Phone:631-361-9338
Mailing Address - Fax:631-653-1440
Practice Address - Street 1:222 E MIDDLE COUNTRY RD STE 210
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2814
Practice Address - Country:US
Practice Address - Phone:631-361-9338
Practice Address - Fax:631-653-1440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-24
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008936261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01103433Medicaid