Provider Demographics
NPI:1700195450
Name:SOUTH BEACH PSYCHIATRIC CENTER
Entity Type:Organization
Organization Name:SOUTH BEACH PSYCHIATRIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF SERVICE
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:HUGH
Authorized Official - Last Name:FELDLER
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:718-667-2495
Mailing Address - Street 1:777 SEAVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-3409
Mailing Address - Country:US
Mailing Address - Phone:718-667-2495
Mailing Address - Fax:718-667-2331
Practice Address - Street 1:250 BALTIC ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-6401
Practice Address - Country:US
Practice Address - Phone:718-855-3131
Practice Address - Fax:718-855-4011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0018761251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health