Provider Demographics
NPI:1639660277
Name:SAINT ANDREWS NEUROSCIENCE(MEDICAL NEUROPSYCHIATRY)LLC
Entity Type:Organization
Organization Name:SAINT ANDREWS NEUROSCIENCE(MEDICAL NEUROPSYCHIATRY)LLC
Other - Org Name:SKANEATELES PSYCHIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:OLUMUYIWA
Authorized Official - Middle Name:ROBBERT
Authorized Official - Last Name:GAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-857-5971
Mailing Address - Street 1:7 FENNELL ST LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:SKANEATELES
Mailing Address - State:NY
Mailing Address - Zip Code:13152-1196
Mailing Address - Country:US
Mailing Address - Phone:315-857-5971
Mailing Address - Fax:
Practice Address - Street 1:7 FENNELL ST LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:SKANEATELES
Practice Address - State:NY
Practice Address - Zip Code:13152
Practice Address - Country:US
Practice Address - Phone:315-857-5971
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAINT ANDREWS NEUROSCIENCE(MEDICAL NEUROPSYCHIATRY)LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-18
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1014161041C0700X
NY2476032084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty