Provider Demographics
NPI:1811263429
Name:JULIAN M. HERSKOWITZ PH.D., PSYCHOLOGIST, P.C.
Entity type:Organization
Organization Name:JULIAN M. HERSKOWITZ PH.D., PSYCHOLOGIST, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HERSKOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:631-549-8867
Mailing Address - Street 1:755 PARK AVE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-3975
Mailing Address - Country:US
Mailing Address - Phone:631-549-8867
Mailing Address - Fax:631-423-8446
Practice Address - Street 1:755 PARK AVE
Practice Address - Street 2:SUITE 140
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3975
Practice Address - Country:US
Practice Address - Phone:631-549-8867
Practice Address - Fax:631-423-8446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-28
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006644103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1811263429OtherMEDICARE NPI
NYA100066565OtherMEDICARE P-TAN