Provider Demographics
NPI:1649320383
Name:OMNI PSYCHIATRIC SERVICES PC
Entity type:Organization
Organization Name:OMNI PSYCHIATRIC SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIKHAIL
Authorized Official - Middle Name:V
Authorized Official - Last Name:NICKITA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-730-7777
Mailing Address - Street 1:42 GRANDVIEW CIRCLE
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030
Mailing Address - Country:US
Mailing Address - Phone:212-730-7777
Mailing Address - Fax:212-730-7797
Practice Address - Street 1:42 GRANDVIEW CIR
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-1314
Practice Address - Country:US
Practice Address - Phone:212-730-7777
Practice Address - Fax:516-365-2591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1689922783OtherNPI