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General NPI Number Information
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NPI Number | 1598857393
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Entity Type | Individual
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Provider Name | RICHARD JOEL ALTSHULER PHD
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Gender | Male
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 12/04/2012
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Provider Practice Location Address
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Address Line | 1955 MERRICK ROAD SUITE 204
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City | MERRICK
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State | NY
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Zip | 11566-4635
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Country | US
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Telephone | 516-379-4414
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Fax | 516-379-1977
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Provider Business Mailing Address
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Address Line | 1955 MERRICK ROAD SUITE 204
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City | MERRICK
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State | NY
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Zip | 11566-4635
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Country | US
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Telephone | 516-379-4414
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Fax | 516-379-1977
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 004336
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License Number State | NY
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