Provider Demographics
NPI:1700191293
Name:SHELTER ROCK PSYCHIATRIC SERVICES, P.C.
Entity Type:Organization
Organization Name:SHELTER ROCK PSYCHIATRIC SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:NASS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-321-7697
Mailing Address - Street 1:580 SUNRISE HWY
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-6000
Mailing Address - Country:US
Mailing Address - Phone:631-321-7697
Mailing Address - Fax:631-321-6140
Practice Address - Street 1:580 SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-6000
Practice Address - Country:US
Practice Address - Phone:631-321-7697
Practice Address - Fax:631-321-6140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1286972084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY128697OtherNYS LICENSE NUMBER