Provider Demographics
NPI:1821305368
Name:LONG ISLAND PSYCHIATRIC SERVICES P.C.
Entity Type:Organization
Organization Name:LONG ISLAND PSYCHIATRIC SERVICES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:R
Authorized Official - Last Name:ALZAMORA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-512-2952
Mailing Address - Street 1:2280 GRAND AVE
Mailing Address - Street 2:SUITE 207A
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-3164
Mailing Address - Country:US
Mailing Address - Phone:516-442-5151
Mailing Address - Fax:516-442-5152
Practice Address - Street 1:2280 GRAND AVE
Practice Address - Street 2:SUITE 207A
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-3164
Practice Address - Country:US
Practice Address - Phone:516-442-5151
Practice Address - Fax:516-442-5152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-03
Last Update Date:2010-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2419982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty