Provider Demographics
NPI:1710429030
Name:EAST END COMPREHENSIVE PSYCHOLOGICAL SERVICES, P.C.
Entity Type:Organization
Organization Name:EAST END COMPREHENSIVE PSYCHOLOGICAL SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ILANI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:646-873-0088
Mailing Address - Street 1:404 E 66TH ST
Mailing Address - Street 2:APT. 4-C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-9308
Mailing Address - Country:US
Mailing Address - Phone:646-873-0088
Mailing Address - Fax:
Practice Address - Street 1:145 E 27TH ST
Practice Address - Street 2:SUITE 1-G
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-9017
Practice Address - Country:US
Practice Address - Phone:646-873-0088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-17
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015913103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty