Provider Demographics
NPI:1497216675
Name:R & V NP IN PSYCHIATRIC SERVICES PLLC
Entity Type:Organization
Organization Name:R & V NP IN PSYCHIATRIC SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:REAGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANUSIONWU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-309-0381
Mailing Address - Street 1:1850 LAFAYETTE AVE APT 6E
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-2837
Mailing Address - Country:US
Mailing Address - Phone:646-844-0518
Mailing Address - Fax:
Practice Address - Street 1:340 TRINITY PL
Practice Address - Street 2:
Practice Address - City:MALVERNE
Practice Address - State:NY
Practice Address - Zip Code:11565-1248
Practice Address - Country:US
Practice Address - Phone:917-557-6064
Practice Address - Fax:917-591-4505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-28
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03623232Medicaid