Provider Demographics
NPI:1043606015
Name:BEHAVIORAL HEALTH NURSE PRACTITIONER PSYCHIATRIC SERVICES PC
Entity Type:Organization
Organization Name:BEHAVIORAL HEALTH NURSE PRACTITIONER PSYCHIATRIC SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:COANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-681-4754
Mailing Address - Street 1:28 ANNANDALE RD
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-1745
Mailing Address - Country:US
Mailing Address - Phone:631-387-1496
Mailing Address - Fax:631-893-4020
Practice Address - Street 1:28 ANNANDALE RD
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-1745
Practice Address - Country:US
Practice Address - Phone:631-387-1496
Practice Address - Fax:631-893-4020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-07
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF401327363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty