Healthcare Provider Details

I. General information

NPI: 1841354131
Provider Name (Legal Business Name): PSCH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 02/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10154 117TH ST
SOUTH RICHMOND HILL NY
11419-1906
US

IV. Provider business mailing address

142-02 20TH AVENUE 3RD FLOOR
FLUSHING NY
11351
US

V. Phone/Fax

Practice location:
  • Phone: 718-846-4007
  • Fax:
Mailing address:
  • Phone: 718-559-0555
  • Fax: 718-445-7111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number01547608
License Number StateNY

VIII. Authorized Official

Name: MS. JACQUELINE RIVERA-HERRERA
Title or Position: VP OF FINANCE FOR CLINICAL SERVICES
Credential:
Phone: 347-542-4217