Healthcare Provider Details

I. General information

NPI: 1568209336
Provider Name (Legal Business Name): MASHADI BIKKUR CHOLIM, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2024
Last Update Date: 07/10/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 EAST SHORE ROAD SUITE 206
MANHASSET NY
11030
US

IV. Provider business mailing address

6 BREEZE COURT
GREAT NECK NY
11024
US

V. Phone/Fax

Practice location:
  • Phone: 516-814-2666
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: BRIAN HAKIMIAN
Title or Position: DIRECTOR OF MASHADI BIKKUR CHOLIM L
Credential:
Phone: 516-984-5869