Provider Demographics
NPI:1861794919
Name:SUFFOLK COUNTY NEUROPSYCHOLOGICAL SERVICES, PLLC
Entity type:Organization
Organization Name:SUFFOLK COUNTY NEUROPSYCHOLOGICAL SERVICES, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:BARNOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:631-366-3369
Mailing Address - Street 1:77 MEDFORD AVENUE
Mailing Address - Street 2:SUITE D
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-9999
Mailing Address - Country:US
Mailing Address - Phone:631-366-3369
Mailing Address - Fax:631-366-2043
Practice Address - Street 1:77 MEDFORD AVENUE
Practice Address - Street 2:SUITE D
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-9999
Practice Address - Country:US
Practice Address - Phone:631-366-3369
Practice Address - Fax:631-366-2043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-23
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011687-1103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty