Provider Demographics
NPI:1851766000
Name:J. M. AQUINO PSYCHOLOGIST PLLC
Entity Type:Organization
Organization Name:J. M. AQUINO PSYCHOLOGIST PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:MARIO
Authorized Official - Last Name:AQUINO
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:914-253-0429
Mailing Address - Street 1:10 RYE RIDGE PLZ
Mailing Address - Street 2:SUITE 214
Mailing Address - City:RYE BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:10573-2828
Mailing Address - Country:US
Mailing Address - Phone:914-253-9429
Mailing Address - Fax:914-777-3852
Practice Address - Street 1:10 RYE RIDGE PLZ
Practice Address - Street 2:SUITE 214
Practice Address - City:RYE BROOK
Practice Address - State:NY
Practice Address - Zip Code:10573-2828
Practice Address - Country:US
Practice Address - Phone:914-253-9429
Practice Address - Fax:914-777-3852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-13
Last Update Date:2015-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009291103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV55883Medicare PIN
NYR27366Medicare UPIN