Provider Demographics
NPI:1689922783
Name:OMNI PSYCHIATRIC SERVICES PC
Entity Type:Organization
Organization Name:OMNI PSYCHIATRIC SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:AMELIA
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-730-7777
Mailing Address - Street 1:1430 BROADWAY RM 1608
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-3363
Mailing Address - Country:US
Mailing Address - Phone:212-730-7777
Mailing Address - Fax:212-730-7797
Practice Address - Street 1:42 GRANDVIEW CIR
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-1314
Practice Address - Country:US
Practice Address - Phone:516-365-2591
Practice Address - Fax:212-730-7797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215211101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty