Provider Demographics
NPI:1649532797
Name:NORTH SHORE CHILD PSYCHIATRY PC
Entity type:Organization
Organization Name:NORTH SHORE CHILD PSYCHIATRY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ASRA
Authorized Official - Middle Name:F
Authorized Official - Last Name:SIDDIQI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-623-6868
Mailing Address - Street 1:6277 JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-2837
Mailing Address - Country:US
Mailing Address - Phone:631-628-6868
Mailing Address - Fax:631-628-6869
Practice Address - Street 1:6277 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-2837
Practice Address - Country:US
Practice Address - Phone:631-628-6868
Practice Address - Fax:631-628-6869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-14
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2326782084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty