Provider Demographics
NPI:1023626678
Name:RA PSYCHIATRIC NP SERVICES PLLC
Entity type:Organization
Organization Name:RA PSYCHIATRIC NP SERVICES PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:REAGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANUSIONWU
Authorized Official - Suffix:
Authorized Official - Credentials:NPP
Authorized Official - Phone:917-557-6064
Mailing Address - Street 1:2722 HERING AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-5321
Mailing Address - Country:US
Mailing Address - Phone:917-557-6064
Mailing Address - Fax:917-591-4505
Practice Address - Street 1:2722 HERING AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-5321
Practice Address - Country:US
Practice Address - Phone:917-557-6064
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-20
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty