Provider Demographics
NPI:1104348283
Name:COMPREHENSIVE NEUROPSYCHOLOGY SERVICES PC
Entity type:Organization
Organization Name:COMPREHENSIVE NEUROPSYCHOLOGY SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUBA
Authorized Official - Middle Name:
Authorized Official - Last Name:NAKHUTINA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:917-740-8195
Mailing Address - Street 1:880 W 181ST ST APT 5A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-4474
Mailing Address - Country:US
Mailing Address - Phone:917-740-8195
Mailing Address - Fax:
Practice Address - Street 1:99 MADISON AVE FL 5
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-7419
Practice Address - Country:US
Practice Address - Phone:917-740-8195
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-11
Last Update Date:2017-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty