Healthcare Provider Details

I. General information

NPI: 1346159498
Provider Name (Legal Business Name): COLLECTIVE CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E MERRICK RD
VALLEY STREAM NY
11580-5920
US

IV. Provider business mailing address

76 UNION AVE APT 4
BROOKLYN NY
11206-4978
US

V. Phone/Fax

Practice location:
  • Phone: 516-830-3338
  • Fax:
Mailing address:
  • Phone: 516-830-3338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ISRAEL WEINSTOCK
Title or Position: PRESIDENT
Credential:
Phone: 516-830-3338