Provider Demographics
NPI:1568880771
Name:LONG ISLAND CHILD PSYCHIATRY, PLLC
Entity Type:Organization
Organization Name:LONG ISLAND CHILD PSYCHIATRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:TOWNSEND
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:631-343-3140
Mailing Address - Street 1:100 S JERSEY AVE
Mailing Address - Street 2:UNIT #1
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-2034
Mailing Address - Country:US
Mailing Address - Phone:631-343-3140
Mailing Address - Fax:631-343-3124
Practice Address - Street 1:100 S JERSEY AVE
Practice Address - Street 2:UNIT #1
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-2034
Practice Address - Country:US
Practice Address - Phone:631-343-3140
Practice Address - Fax:631-343-3124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-03
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2485882084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty