| Dlk Psyd Psychologist | |
|
10 Grace Ave Ste 7 Great Neck NY 11021-2423 | |
| (516) 479-4350 | |
| (516) 706-4448 |
| Full Name | Dlk Psyd Psychologist |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 10 Grace Ave Ste 7, Great Neck, New York |
| Authorized Official Name and Position | Dustin Kahoud (OWNER) |
| Authorized Official Contact | 5164794350 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dlk Psyd Psychologist 10 Grace Ave Ste 7 Great Neck NY 11021-2423 Ph: (516) 479-4350 | Dlk Psyd Psychologist 10 Grace Ave Ste 7 Great Neck NY 11021-2423 Ph: (516) 479-4350 |
| NPI Number | 1659746055 |
|---|---|
| Provider Enumeration Date | 12/10/2015 |
| Last Update Date | 04/29/2022 |
| Certification Date | 04/29/2022 |
| Medicare PECOS PAC ID | 3779886908 |
|---|---|
| Medicare Enrollment ID | O20160122000195 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659746055 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 021201 (New York) | Primary |
| Provider Name | Dustin Kahoud |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1518349695 PECOS PAC ID: 4688977812 Enrollment ID: I20160122000394 |
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