Provider Demographics
NPI:1750620035
Name:NASSAU SUFFOLK PSYCHIATRY PC
Entity type:Organization
Organization Name:NASSAU SUFFOLK PSYCHIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAHIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-222-2747
Mailing Address - Street 1:17 BUTTONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-4802
Mailing Address - Country:US
Mailing Address - Phone:516-222-2747
Mailing Address - Fax:516-222-2784
Practice Address - Street 1:1975 HEMPSTEAD TPKE
Practice Address - Street 2:SUITE 208
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-1758
Practice Address - Country:US
Practice Address - Phone:516-222-2747
Practice Address - Fax:516-222-2784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2216492084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty