Provider Demographics
NPI:1629847124
Name:SOUTH SHORE NP PSYCHIATRY, PLLC
Entity Type:Organization
Organization Name:SOUTH SHORE NP PSYCHIATRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:
Authorized Official - First Name:TATYANA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOYKHBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:347-741-9301
Mailing Address - Street 1:3330 PARK AVENUE
Mailing Address - Street 2:SUITE 9 2ND FLOOR
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-3719
Mailing Address - Country:US
Mailing Address - Phone:516-931-0619
Mailing Address - Fax:516-879-3099
Practice Address - Street 1:3330 PARK AVENUE
Practice Address - Street 2:SUITE 9 2ND FLOOR
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-3719
Practice Address - Country:US
Practice Address - Phone:516-931-0619
Practice Address - Fax:516-879-3099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-26
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty