Provider Demographics
NPI:1790483766
Name:EC PSYCHIATRIC NURSE PRACTITIONER PLLC
Entity Type:Organization
Organization Name:EC PSYCHIATRIC NURSE PRACTITIONER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER PSYCHIATRY
Authorized Official - Prefix:
Authorized Official - First Name:EDNER
Authorized Official - Middle Name:
Authorized Official - Last Name:CUVILLY
Authorized Official - Suffix:
Authorized Official - Credentials:NPP
Authorized Official - Phone:646-671-1187
Mailing Address - Street 1:115 FRANKLIN TURNPIKE
Mailing Address - Street 2:PO BOX 168
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430
Mailing Address - Country:US
Mailing Address - Phone:646-671-1187
Mailing Address - Fax:
Practice Address - Street 1:21 ROBIN HOOD RD
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-3820
Practice Address - Country:US
Practice Address - Phone:646-671-1187
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty