Provider Demographics
NPI:1033232467
Name:BEHAVIORAL HEALTH MEDICAL PRACTICE P.C.
Entity Type:Organization
Organization Name:BEHAVIORAL HEALTH MEDICAL PRACTICE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOATAZ
Authorized Official - Middle Name:YOUSEF
Authorized Official - Last Name:HAGGAG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-758-2815
Mailing Address - Street 1:110 FIG DR
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-5657
Mailing Address - Country:US
Mailing Address - Phone:631-758-2815
Mailing Address - Fax:631-206-9299
Practice Address - Street 1:240 PATCHOGUE YAPHANK RD
Practice Address - Street 2:SUITE 211
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-4868
Practice Address - Country:US
Practice Address - Phone:631-758-2815
Practice Address - Fax:631-206-9299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY227462174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02986065Medicaid
NY02986065Medicaid
NYWZWVW1Medicare PIN