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General NPI Number Information
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NPI Number | 1811897671
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Entity Type | Individual
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Provider Name | ELLY MAX DEUTSCH PSYD
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Gender | Male
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Dates
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Enumeration Date | 11/06/2026
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Last Update Date | 11/06/2026
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Provider Practice Location Address
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Address Line | 1212 SEAGIRT BLVD
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City | FAR ROCKAWAY
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State | NY
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Zip | 11691-5614
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Country | US
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Telephone | 516-696-9540
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Fax | 516-696-9541
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Provider Business Mailing Address
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Address Line | 212 BEACH 13TH ST STE 301
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City | FAR ROCKAWAY
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State | NY
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Zip | 11691-5614
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Country | US
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Telephone | 516-696-9540
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Fax | 516-696-9541
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 028553
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License Number State | NY
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