Provider Demographics
NPI:1164640405
Name:LONG ISLAND PSYCHIATRIC, PLLC
Entity Type:Organization
Organization Name:LONG ISLAND PSYCHIATRIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:BURTON
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:516-626-2182
Mailing Address - Street 1:43 GLEN COVE RD STE B157
Mailing Address - Street 2:
Mailing Address - City:GREENVALE
Mailing Address - State:NY
Mailing Address - Zip Code:11548-1033
Mailing Address - Country:US
Mailing Address - Phone:516-626-2182
Mailing Address - Fax:917-942-8887
Practice Address - Street 1:43 GLEN COVE RD STE B157
Practice Address - Street 2:
Practice Address - City:GREENVALE
Practice Address - State:NY
Practice Address - Zip Code:11548-1033
Practice Address - Country:US
Practice Address - Phone:516-626-2182
Practice Address - Fax:917-942-8887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206446174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty