Healthcare Provider Details

I. General information

NPI: 1700056496
Provider Name (Legal Business Name): PDG PSYCHOLOGICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2008
Last Update Date: 03/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 BUTLER HILL RD
SOMERS NY
10589-2405
US

IV. Provider business mailing address

38 BUTLER HILL RD
SOMERS NY
10589-2405
US

V. Phone/Fax

Practice location:
  • Phone: 914-276-0386
  • Fax:
Mailing address:
  • Phone: 914-276-0386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number041801
License Number StateNY

VIII. Authorized Official

Name: DR. PHILIP D GOLDSTEIN
Title or Position: PRESIDENT
Credential: PHD
Phone: 914-276-2474