Provider Demographics
NPI:1487718771
Name:PSCH. INC
Entity type:Organization
Organization Name:PSCH. INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE CLINICAL SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA-HERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-542-4217
Mailing Address - Street 1:142-02 20TH AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11351
Mailing Address - Country:US
Mailing Address - Phone:718-559-0555
Mailing Address - Fax:
Practice Address - Street 1:18918 STATION RD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-2832
Practice Address - Country:US
Practice Address - Phone:718-460-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY01255967261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01255967Medicaid