Provider Demographics
NPI:1740206010
Name:NEUROPSYCHOLOGIC REHABILITATION SERVICES PC
Entity Type:Organization
Organization Name:NEUROPSYCHOLOGIC REHABILITATION SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KARI
Authorized Official - Middle Name:
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-392-7314
Mailing Address - Street 1:300 WASHINGTON AVE. EXT.
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12037-7303
Mailing Address - Country:US
Mailing Address - Phone:518-392-7314
Mailing Address - Fax:518-862-2175
Practice Address - Street 1:300 WASHINGTON AVE. EXT.
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203
Practice Address - Country:US
Practice Address - Phone:518-392-7314
Practice Address - Fax:518-862-2175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011531103G00000X
NY0096811103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5096818OtherWORKERS COMP
NY01416751Medicaid
NY01416760Medicaid
NY01905259Medicaid
NY5096818OtherWORKERS COMP
NY01416751Medicaid