Provider Demographics
NPI:1750417408
Name:ADVANCED PSYCHOLOGICAL ASSESSMENT, P.C.
Entity type:Organization
Organization Name:ADVANCED PSYCHOLOGICAL ASSESSMENT, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHAL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROZENBLATT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:631-378-0741
Mailing Address - Street 1:50 KARL AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2744
Mailing Address - Country:US
Mailing Address - Phone:631-378-0741
Mailing Address - Fax:
Practice Address - Street 1:50 KARL AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2744
Practice Address - Country:US
Practice Address - Phone:631-378-0741
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016095103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty