Provider Demographics
NPI:1093088502
Name:WINGSPAN PSYCHIATRIC, LLC
Entity Type:Organization
Organization Name:WINGSPAN PSYCHIATRIC, LLC
Other - Org Name:FRANCIS HAYDEN, M.D.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYDEN
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:914-413-1553
Mailing Address - Street 1:101 ELLWOOD AVE APT 4A
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552-3428
Mailing Address - Country:US
Mailing Address - Phone:914-413-1553
Mailing Address - Fax:917-791-8239
Practice Address - Street 1:138 S COLUMBUS AVE FL 1
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10553-1337
Practice Address - Country:US
Practice Address - Phone:914-413-1553
Practice Address - Fax:978-701-6001
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WINGSPAN PSYCHIATRIC LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-14
Last Update Date:2020-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1898452084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01550791Medicaid
NY03438319Medicaid