Provider Demographics
NPI:1720190911
Name:ADVANCED PSYCHIATRIC PC
Entity Type:Organization
Organization Name:ADVANCED PSYCHIATRIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESEDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BUKHOLTS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-581-1300
Mailing Address - Street 1:30 W 60TH ST
Mailing Address - Street 2:SUITE 1N
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-7902
Mailing Address - Country:US
Mailing Address - Phone:212-581-1300
Mailing Address - Fax:212-581-4466
Practice Address - Street 1:30 W 60TH ST
Practice Address - Street 2:SUITE 1N
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-7902
Practice Address - Country:US
Practice Address - Phone:212-581-1300
Practice Address - Fax:212-581-4466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY202438174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01733297Medicaid
NYG45244Medicare UPIN
NYWVC921Medicare PIN