Provider Demographics
NPI:1629593298
Name:K MARK SOSSIN PHD & JAN CHARONE-SOSSIN PHD, CLINICAL PSYCHOLOGISTS PC
Entity Type:Organization
Organization Name:K MARK SOSSIN PHD & JAN CHARONE-SOSSIN PHD, CLINICAL PSYCHOLOGISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:K
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:SOSSIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:516-326-2401
Mailing Address - Street 1:1893 STEWART AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-1623
Mailing Address - Country:US
Mailing Address - Phone:516-326-2401
Mailing Address - Fax:516-326-6973
Practice Address - Street 1:1893 STEWART AVE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040
Practice Address - Country:US
Practice Address - Phone:516-326-2401
Practice Address - Fax:516-326-6973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007223261QM0801X
NY007228261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)