MEDICARE: LONG ISLAND PSYCHOLOGICAL SERVICES COMPANY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	007310	NY

General Provider Information

NPI Number	:	1386728566
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LONG ISLAND PSYCHOLOGICAL SERVICES COMPANY

Provider Business Mailing Address
First Line	:	300 GARDEN CITY PLZ STE 400
Second Line	:
City	:	GARDEN CITY
State	:	NY
Zip	:	11530-3332
Country	:	US
Telephone Number	:	516-248-0006
Fax Number	:	516-248-0603

Provider Business Practice Location Address
First Line	:	300 GARDEN CITY PLZ STE 400
Second Line	:
City	:	GARDEN CITY
State	:	NY
Zip	:	11530-3332
Country	:	US
Telephone Number	:	516-248-0006
Fax Number	:	516-248-0603

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RALPH VICTOR KAPLAN
Credential	:	PHD
Telephone Number	:	516-248-0006

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	07/14/2008

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