Basic Information
| Provider Information | |||||||||
| NPI: | 1245616069 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVANCED CENTER FOR PSYCHOTHERAPY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10326 68TH RD | ||||||||
| Address2: | |||||||||
| City: | FOREST HILLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113753200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182613330 | ||||||||
| FaxNumber: | 7186587091 | ||||||||
| Practice Location | |||||||||
| Address1: | 10326 68TH RD | ||||||||
| Address2: | |||||||||
| City: | FOREST HILLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113753200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182613330 | ||||||||
| FaxNumber: | 7186587091 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2015 | ||||||||
| LastUpdateDate: | 08/04/2015 | ||||||||
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| AuthorizedOfficialLastName: | BAMJI | ||||||||
| AuthorizedOfficialFirstName: | DINSHAW | ||||||||
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| AuthorizedOfficialTitleorPosition: | ASSOCIATE CHAIRMAN | ||||||||
| AuthorizedOfficialTelephone: | 7182613330 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | JAMAICA HOSPITAL MEDICAL CENTER | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0855X | P98809 | NY | N | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | 261QM0850X | P98809 | NY | Y | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |
No ID Information.