Provider Demographics
NPI:1629438726
Name:SAFE HARBOR PSYCHIATRIC SERVICES, PLLC
Entity Type:Organization
Organization Name:SAFE HARBOR PSYCHIATRIC SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:L
Authorized Official - Last Name:NODARSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-923-5099
Mailing Address - Street 1:PO BOX 482
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-0482
Mailing Address - Country:US
Mailing Address - Phone:845-364-8221
Mailing Address - Fax:845-364-8221
Practice Address - Street 1:978 ROUTE 45
Practice Address - Street 2:SUITE 203
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-3521
Practice Address - Country:US
Practice Address - Phone:845-364-8221
Practice Address - Fax:845-364-8221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-02
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty