Healthcare Provider Details

I. General information

NPI: 1851940969
Provider Name (Legal Business Name): QUEENS NEUROPSYCHOLOGICAL SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2019
Last Update Date: 01/02/2020
Certification Date: 01/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25418 NORTHERN BLVD STE 3
LITTLE NECK NY
11362-1451
US

IV. Provider business mailing address

3233 202ND ST
BAYSIDE NY
11361-1017
US

V. Phone/Fax

Practice location:
  • Phone: 646-389-2283
  • Fax:
Mailing address:
  • Phone: 646-389-2283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. ELSA LEE
Title or Position: PSYCHOLOGIST/OWNER
Credential: PH.D.
Phone: 646-389-2283