Provider Demographics
NPI:1164693305
Name:A I B H NURSE PRACTITIONER-PSCYHIATRY PLLC
Entity Type:Organization
Organization Name:A I B H NURSE PRACTITIONER-PSCYHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSSELAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-689-5433
Mailing Address - Street 1:3771 NESCONSET HWY STE 212
Mailing Address - Street 2:
Mailing Address - City:SOUTH SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11720-1154
Mailing Address - Country:US
Mailing Address - Phone:631-689-5433
Mailing Address - Fax:631-883-6652
Practice Address - Street 1:3771 NESCONSET HWY STE 212
Practice Address - Street 2:
Practice Address - City:SOUTH SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11720-1154
Practice Address - Country:US
Practice Address - Phone:631-689-5390
Practice Address - Fax:631-883-6652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-16
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP35142Medicare UPIN
NYS47139Medicare UPIN