Healthcare Provider Details

I. General information

NPI: 1699199869
Provider Name (Legal Business Name): SUNRISE PSYCHOLOGICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2014
Last Update Date: 02/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 ROYAL CREST DR
PROSPECT CT
06712-1486
US

IV. Provider business mailing address

PO BOX 1250
MONSEY NY
10952-8349
US

V. Phone/Fax

Practice location:
  • Phone: 845-826-0060
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: JOEL MEISELS
Title or Position: PRESIDENT
Credential:
Phone: 845-826-0060