Provider Demographics
NPI:1861038903
Name:MANCHANDANI PSYCHOLOGICAL SERVICES, PLLC
Entity Type:Organization
Organization Name:MANCHANDANI PSYCHOLOGICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JYOTI
Authorized Official - Middle Name:SUCHDEV
Authorized Official - Last Name:MANCHANDANI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:631-662-9049
Mailing Address - Street 1:37 WHITE CLIFF LN
Mailing Address - Street 2:
Mailing Address - City:NESCONSET
Mailing Address - State:NY
Mailing Address - Zip Code:11767-1625
Mailing Address - Country:US
Mailing Address - Phone:631-662-9049
Mailing Address - Fax:
Practice Address - Street 1:1919 MIDDLE COUNTRY RD STE 308
Practice Address - Street 2:
Practice Address - City:CENTEREACH
Practice Address - State:NY
Practice Address - Zip Code:11720-3501
Practice Address - Country:US
Practice Address - Phone:631-662-9049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty