Provider Demographics
NPI:1922020593
Name:PROFESSIONAL THERAPEUTIC ASSOCIATES
Entity Type:Organization
Organization Name:PROFESSIONAL THERAPEUTIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SORSCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-625-4446
Mailing Address - Street 1:250 ROUND HILL RD
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-1537
Mailing Address - Country:US
Mailing Address - Phone:516-625-4446
Mailing Address - Fax:
Practice Address - Street 1:250 ROUND HILL RD
Practice Address - Street 2:
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577-1537
Practice Address - Country:US
Practice Address - Phone:516-625-4446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02194214Medicaid
NY02194214Medicaid
NYV5W901Medicare ID - Type Unspecified