Healthcare Provider Details

I. General information

NPI: 1104143353
Provider Name (Legal Business Name): JAY MICHAEL SILVERSTEIN PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2010
Last Update Date: 04/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W PARK AVE SUITE 2
LONG BEACH NY
11561-3301
US

IV. Provider business mailing address

120 W PARK AVE SUITE 2
LONG BEACH NY
11561-3301
US

V. Phone/Fax

Practice location:
  • Phone: 516-507-4678
  • Fax: 516-889-9135
Mailing address:
  • Phone: 516-507-4678
  • Fax: 516-889-9135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number011020-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: