Provider Demographics
NPI:1396071825
Name:NY CENTER FOR BEHAVIORAL HEALTH, INC.
Entity type:Organization
Organization Name:NY CENTER FOR BEHAVIORAL HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KLUGER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:516-487-4202
Mailing Address - Street 1:287 NORTHERN BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-4717
Mailing Address - Country:US
Mailing Address - Phone:516-487-4202
Mailing Address - Fax:201-692-0234
Practice Address - Street 1:287 NORTHERN BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-4717
Practice Address - Country:US
Practice Address - Phone:516-487-4202
Practice Address - Fax:201-692-0234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-17
Last Update Date:2018-03-27
Deactivation Date:2018-03-20
Deactivation Code:
Reactivation Date:2018-03-27
Provider Licenses
StateLicense IDTaxonomies
NY10139103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty