Healthcare Provider Details

I. General information

NPI: 1548205784
Provider Name (Legal Business Name): UNITED STATES MEMORY CHECK PSYCHOLOGY SERVICES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 01/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3512 QUENTIN RD SUITE 140
BROOKLYN NY
11234-4231
US

IV. Provider business mailing address

3512 QUENTIN RD SUITE 140
BROOKLYN NY
11234-4231
US

V. Phone/Fax

Practice location:
  • Phone: 347-633-3052
  • Fax: 718-854-8369
Mailing address:
  • Phone: 347-633-3052
  • Fax: 718-854-8369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number059213
License Number StateNY

VIII. Authorized Official

Name: DR. ISRAEL RUBINSTEIN
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 718-854-8370