Healthcare Provider Details

I. General information

NPI: 1992050512
Provider Name (Legal Business Name): EVAN SKOLNIK PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2012
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 NEW YORK AVE STE 101
SMITHTOWN NY
11787-3448
US

IV. Provider business mailing address

440 BROOKLYN BLVD
BRIGHTWATERS NY
11718-1002
US

V. Phone/Fax

Practice location:
  • Phone: 631-652-3361
  • Fax:
Mailing address:
  • Phone: 631-352-2638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number025569
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: