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General NPI Number Information
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NPI Number | 1346831617
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Entity Type | Organization
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Legal Business Name | PEDIATRIC AND YOUNG ADULT PSYCHOLOGICAL SERVICES OF NEW YORK
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Dates
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Enumeration Date | 01/29/2021
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Last Update Date | 01/29/2021
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Provider Practice Location Address
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Address Line | 280 MADISON AVE RM 1403
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City | NEW YORK
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State | NY
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Zip | 10016-0801
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Country | US
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Telephone | 718-675-4710
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Fax |
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Provider Business Mailing Address
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Address Line | 280 MADISON AVE RM 1403
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City | NEW YORK
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State | NY
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Zip | 10016-0801
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Country | US
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Telephone | 718-675-4710
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. STANISLAV ROYZMAN
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Credential | PSY.D., M.S.ED
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Telephone | 718-675-4710
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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