Healthcare Provider Details

I. General information

NPI: 1154157626
Provider Name (Legal Business Name): PSYCHOLOGICAL RESTORATIVE SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2024
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

283 COMMACK RD STE 210
COMMACK NY
11725-3400
US

IV. Provider business mailing address

283 COMMACK RD STE 210
COMMACK NY
11725-3400
US

V. Phone/Fax

Practice location:
  • Phone: 631-499-7500
  • Fax:
Mailing address:
  • Phone: 631-499-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT I GOLDMAN
Title or Position: OWNER
Credential: JD, PSYD
Phone: 631-499-7500