Provider Demographics
NPI:1811280795
Name:WILLO WISOTSKY, PHD-PSYCHOLOGIST, PC
Entity type:Organization
Organization Name:WILLO WISOTSKY, PHD-PSYCHOLOGIST, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLO
Authorized Official - Middle Name:
Authorized Official - Last Name:WISOTSKY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:631-804-8830
Mailing Address - Street 1:10 FOLGER LN
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-5805
Mailing Address - Country:US
Mailing Address - Phone:631-804-8830
Mailing Address - Fax:
Practice Address - Street 1:35 CROOKED HILL RD STE 203
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-5415
Practice Address - Country:US
Practice Address - Phone:631-804-8830
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016173103TB0200X, 103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealthGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty