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General NPI Number Information
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NPI Number | 1750417408
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Entity Type | Organization
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Legal Business Name | ADVANCED PSYCHOLOGICAL ASSESSMENT, P.C.
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 08/07/2007
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Provider Practice Location Address
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Address Line | 50 KARL AVE SUITE 104
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City | SMITHTOWN
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State | NY
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Zip | 11787-2744
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Country | US
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Telephone | 631-378-0741
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Fax |
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Provider Business Mailing Address
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Address Line | 50 KARL AVE SUITE 104
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City | SMITHTOWN
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State | NY
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Zip | 11787-2744
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Country | US
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Telephone | 631-378-0741
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SHAHAL ROZENBLATT
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Credential | PH.D.
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Telephone | 631-378-0741
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 016095
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License Number State | NY
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