Provider Demographics
NPI:1801248943
Name:MEMORY CHECK PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:MEMORY CHECK PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS RECEIVABLE
Authorized Official - Prefix:
Authorized Official - First Name:DONNEQWA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLURE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-275-3243
Mailing Address - Street 1:155 PINELAWN RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-3245
Mailing Address - Country:US
Mailing Address - Phone:800-275-3243
Mailing Address - Fax:631-393-2688
Practice Address - Street 1:155 PINELAWN RD
Practice Address - Street 2:SUITE 120
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-3245
Practice Address - Country:US
Practice Address - Phone:800-275-3243
Practice Address - Fax:631-393-2688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA315D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1720122831Medicare NSC