Healthcare Provider Details

I. General information

NPI: 1912546953
Provider Name (Legal Business Name): HENRY SAYRE PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2019
Last Update Date: 12/21/2019
Certification Date: 12/21/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 TOMPKINS AVE
STATEN ISLAND NY
10304-2601
US

IV. Provider business mailing address

94 CEDAR LN APT B
HIGHLAND PARK NJ
08904-2043
US

V. Phone/Fax

Practice location:
  • Phone: 718-876-1200
  • Fax:
Mailing address:
  • Phone: 479-806-4330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberP103753
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: