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General NPI Number Information
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NPI Number | 1770853111
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Entity Type | Organization
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Legal Business Name | ADVANCED PSYCHOLOGICAL SERVICES, PC
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Dates
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Enumeration Date | 01/02/2012
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Last Update Date | 01/02/2012
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Provider Practice Location Address
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Address Line | 278 E MAIN ST
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City | SMITHTOWN
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State | NY
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Zip | 11787-2915
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Country | US
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Telephone | 631-361-6960
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Fax | 631-366-5346
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Provider Business Mailing Address
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Address Line | 278 E MAIN ST
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City | SMITHTOWN
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State | NY
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Zip | 11787-2915
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. SIMON ZYSMAN
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Credential | PH.D.
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Telephone | 516-448-9834
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 006483
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License Number State | NY
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