Provider Demographics
NPI:1811165848
Name:OPTIMUM PSYCHOLOGICAL SERVICES PLLC
Entity type:Organization
Organization Name:OPTIMUM PSYCHOLOGICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EVA
Authorized Official - Middle Name:
Authorized Official - Last Name:NG
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:718-437-3558
Mailing Address - Street 1:833 58TH ST STE 3R
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-3609
Mailing Address - Country:US
Mailing Address - Phone:718-437-3558
Mailing Address - Fax:718-437-6368
Practice Address - Street 1:833 58TH ST STE 3R
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-3609
Practice Address - Country:US
Practice Address - Phone:718-437-3558
Practice Address - Fax:718-437-6368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014422103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02145646Medicaid
NY1057050OtherBEACON
NY1096512OtherCIGNA
NY494112OtherVALUE OPTIONS
NY112590201OtherHEALTH PLUS
NY060014422NY01OtherANTHEM
NY228709POtherHIP
NY486556000OtherMAGELLAN
NY7563424OtherAETNA
NY073609645Other1199
NY251261OtherHEALTH NET
NY108388348OtherUNITED BEHAVIORAL HEALTH
NY251261OtherMHN
NY286951OtherWELL CARE
NY228709POtherHIP