Healthcare Provider Details

I. General information

NPI: 1033512215
Provider Name (Legal Business Name): OPTIMAL LIVING PSYCHOLOGICAL SERVICES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2014
Last Update Date: 12/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 LEXINGTON AVE, SUITE #500
NEW YORK NY
10017
US

IV. Provider business mailing address

370 LEXINGTON AVE, SUITE #500
NEW YORK NY
10017
US

V. Phone/Fax

Practice location:
  • Phone: 212-213-8905
  • Fax: 212-213-8905
Mailing address:
  • Phone: 212-213-8905
  • Fax: 212-213-8905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. ANDREW TATARSKY
Title or Position: DIRECTOR
Credential: PHD
Phone: 212-213-8905