Provider Demographics
NPI:1265821953
Name:POSITIVE CHANGE PSYCHIATRY PLLC
Entity Type:Organization
Organization Name:POSITIVE CHANGE PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAMIL
Authorized Official - Middle Name:
Authorized Official - Last Name:ATTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-364-6500
Mailing Address - Street 1:220 FOREST DR
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-2320
Mailing Address - Country:US
Mailing Address - Phone:516-364-6500
Mailing Address - Fax:631-465-9336
Practice Address - Street 1:175 JERICHO TPKE
Practice Address - Street 2:SUITE 301
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-4532
Practice Address - Country:US
Practice Address - Phone:516-364-6500
Practice Address - Fax:631-465-9336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-18
Last Update Date:2015-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2420832084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02896459Medicaid