Provider Demographics
NPI:1356563431
Name:CHERYL S CHITAYAT PSY D PC
Entity type:Organization
Organization Name:CHERYL S CHITAYAT PSY D PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHITAYAT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:631-864-5535
Mailing Address - Street 1:358 VETERANS MEMORIAL HWY.
Mailing Address - Street 2:SUITE 12
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-4332
Mailing Address - Country:US
Mailing Address - Phone:631-864-5535
Mailing Address - Fax:
Practice Address - Street 1:358 VETERANS MEMORIAL HWY.
Practice Address - Street 2:SUITE 12
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-4332
Practice Address - Country:US
Practice Address - Phone:631-864-5535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009723103T00000X, 103TC2200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS09723-8OtherWCB#
NYS09723-8OtherWCB#