Provider Demographics
NPI:1386728566
Name:LONG ISLAND PSYCHOLOGICAL SERVICES COMPANY
Entity type:Organization
Organization Name:LONG ISLAND PSYCHOLOGICAL SERVICES COMPANY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:VICTOR
Authorized Official - Last Name:KAPLAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:516-248-0006
Mailing Address - Street 1:300 GARDEN CITY PLZ STE 400
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-3332
Mailing Address - Country:US
Mailing Address - Phone:516-248-0006
Mailing Address - Fax:516-248-0603
Practice Address - Street 1:300 GARDEN CITY PLZ STE 400
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-3332
Practice Address - Country:US
Practice Address - Phone:516-248-0006
Practice Address - Fax:516-248-0603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007310103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRK0187310Medicare ID - Type Unspecified
NYV18731Medicare UPIN