Provider Demographics
NPI:1649323023
Name:TSYTSAREV, SERGEI (PHD)
Entity type:Individual
Prefix:DR
First Name:SERGEI
Middle Name:
Last Name:TSYTSAREV
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-3233
Mailing Address - Country:US
Mailing Address - Phone:516-676-2525
Mailing Address - Fax:516-676-2525
Practice Address - Street 1:2327 83RD ST
Practice Address - Street 2:SUITE D
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-2750
Practice Address - Country:US
Practice Address - Phone:718-236-0700
Practice Address - Fax:718-232-2625
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013502103TC0700X, 103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01942841Medicaid
NYS79819Medicare UPIN
NY01942841Medicaid