Provider Demographics
NPI:1497842876
Name:SUFFERN PSYCHIATRIC SERVICES LLC
Entity Type:Organization
Organization Name:SUFFERN PSYCHIATRIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAHOMED
Authorized Official - Middle Name:S
Authorized Official - Last Name:BHANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-368-5251
Mailing Address - Street 1:PO BOX 797
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956
Mailing Address - Country:US
Mailing Address - Phone:845-557-0300
Mailing Address - Fax:845-557-0300
Practice Address - Street 1:255 LAFAYETTE AVE
Practice Address - Street 2:GOOD SAMARITAN HOSPITAL BEHAVIOR HEALTH DEPT
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901
Practice Address - Country:US
Practice Address - Phone:845-368-5251
Practice Address - Fax:845-557-0300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1486782084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02753533Medicaid
NYWFW351Medicare PIN