| Keith Woythaler Psychologist, P.c. | |
|
100 N Village Ave Ste 11 Rockville Centre NY 11570-3712 | |
| (516) 851-5381 | |
| Not Available |
| Full Name | Keith Woythaler Psychologist, P.c. |
|---|---|
| Speciality | Psychologist |
| Location | 100 N Village Ave Ste 11, Rockville Centre, New York |
| Authorized Official Name and Position | Keith Woythaler (OWNER) |
| Authorized Official Contact | 5168515381 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Keith Woythaler Psychologist, P.c. 112 N Forest Ave Rockville Centre NY 11570-4304 Ph: (516) 851-5381 | Keith Woythaler Psychologist, P.c. 100 N Village Ave Ste 11 Rockville Centre NY 11570-3712 Ph: (516) 851-5381 |
| NPI Number | 1952815565 |
|---|---|
| Provider Enumeration Date | 11/20/2017 |
| Last Update Date | 08/18/2020 |
| Certification Date | 08/18/2020 |
| Medicare PECOS PAC ID | 7113287509 |
|---|---|
| Medicare Enrollment ID | O20180202001471 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952815565 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Keith Woythaler |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1548415953 PECOS PAC ID: 5496810756 Enrollment ID: I20180123003103 |
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