Provider Demographics
NPI:1952753592
Name:LONG ISLAND PSYCHIATRY, PC
Entity Type:Organization
Organization Name:LONG ISLAND PSYCHIATRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ATMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BENGELOUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-455-1717
Mailing Address - Street 1:9 ARISTA DR
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-4904
Mailing Address - Country:US
Mailing Address - Phone:631-455-1717
Mailing Address - Fax:
Practice Address - Street 1:15 BELLEMEADE AVE
Practice Address - Street 2:SUITE 11
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-1870
Practice Address - Country:US
Practice Address - Phone:631-455-1717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-07
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2164912084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty