Provider Demographics
NPI:1013781871
Name:PSYCHIATRY SERVICES OF NEW YORK PC
Entity Type:Organization
Organization Name:PSYCHIATRY SERVICES OF NEW YORK PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:STACEY
Authorized Official - Last Name:BRONSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-222-3121
Mailing Address - Street 1:9900 BREN RD E
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55343-9664
Mailing Address - Country:US
Mailing Address - Phone:952-246-4564
Mailing Address - Fax:
Practice Address - Street 1:3300 JAMES ST STE 100
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13206-2392
Practice Address - Country:US
Practice Address - Phone:315-422-0300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-13
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty