Healthcare Provider Details

I. General information

NPI: 1912129313
Provider Name (Legal Business Name): MICHAEL HURLEY PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 NEW YORK AVE STE 200
HUNTINGTON NY
11743-4240
US

IV. Provider business mailing address

755 NEW YORK AVE STE 200
HUNTINGTON NY
11743-4240
US

V. Phone/Fax

Practice location:
  • Phone: 631-271-8489
  • Fax: 631-261-9354
Mailing address:
  • Phone: 631-271-8489
  • Fax: 631-261-9354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number9358
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: