Provider Demographics
NPI:1730500554
Name:SH GERIATRIC PSYCHOLOGICAL SERVICES P.C .
Entity Type:Organization
Organization Name:SH GERIATRIC PSYCHOLOGICAL SERVICES P.C .
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYCHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-268-6600
Mailing Address - Street 1:118-35 QUEENS BLVD
Mailing Address - Street 2:SUITE 1403
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-7205
Mailing Address - Country:US
Mailing Address - Phone:718-265-6600
Mailing Address - Fax:718-265-6065
Practice Address - Street 1:125 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-1900
Practice Address - Country:US
Practice Address - Phone:516-858-2665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-20
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015238-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty