Provider Demographics
NPI:1336146901
Name:FOUR WINDS - SARATOGA OUT-PATIENT PSYCHIATRIC SERVICE, P.C.
Entity Type:Organization
Organization Name:FOUR WINDS - SARATOGA OUT-PATIENT PSYCHIATRIC SERVICE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEINSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:914-763-8151
Mailing Address - Street 1:30 CRESCENT AVE
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-5142
Mailing Address - Country:US
Mailing Address - Phone:518-584-3600
Mailing Address - Fax:
Practice Address - Street 1:30 CRESCENT AVE
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-5142
Practice Address - Country:US
Practice Address - Phone:518-584-3600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
53360AMedicare ID - Type Unspecified