Provider Demographics
NPI:1548298508
Name:PSYCHIATRY AND PSYCHOTHERAPY PRACTICE P.C.
Entity type:Organization
Organization Name:PSYCHIATRY AND PSYCHOTHERAPY PRACTICE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAURICIO
Authorized Official - Middle Name:
Authorized Official - Last Name:MURILLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-239-0030
Mailing Address - Street 1:500 EAST 83RD STREET
Mailing Address - Street 2:STE 19M
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-7244
Mailing Address - Country:US
Mailing Address - Phone:718-239-0030
Mailing Address - Fax:718-239-0032
Practice Address - Street 1:500 EAST 83RD STREET
Practice Address - Street 2:STE 19M
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-7244
Practice Address - Country:US
Practice Address - Phone:718-239-0030
Practice Address - Fax:718-239-0032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02657587Medicaid
NY02657587Medicaid