Healthcare Provider Details

I. General information

NPI: 1245616069
Provider Name (Legal Business Name): ADVANCED CENTER FOR PSYCHOTHERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2015
Last Update Date: 08/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10326 68TH RD
FOREST HILLS NY
11375-3200
US

IV. Provider business mailing address

10326 68TH RD
FOREST HILLS NY
11375-3200
US

V. Phone/Fax

Practice location:
  • Phone: 718-261-3330
  • Fax: 718-658-7091
Mailing address:
  • Phone: 718-261-3330
  • Fax: 718-658-7091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberP98809
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberP98809
License Number StateNY

VIII. Authorized Official

Name: DR. DINSHAW BAMJI
Title or Position: ASSOCIATE CHAIRMAN
Credential: M.D.
Phone: 718-261-3330