Provider Demographics
NPI:1871000950
Name:EAST ROCKAWAY NEUROPSYCHOLOGY, PC
Entity type:Organization
Organization Name:EAST ROCKAWAY NEUROPSYCHOLOGY, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUGEL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:516-341-6215
Mailing Address - Street 1:100 MERRICK RD STE 510
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-4800
Mailing Address - Country:US
Mailing Address - Phone:516-341-6215
Mailing Address - Fax:516-744-6743
Practice Address - Street 1:100 MERRICK RD STE 510
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-4800
Practice Address - Country:US
Practice Address - Phone:516-341-6215
Practice Address - Fax:516-744-6743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-10
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021703103G00000X, 103TC0700X
NY021808103TC0700X, 103TC2200X
103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty