Healthcare Provider Details

I. General information

NPI: 1164171872
Provider Name (Legal Business Name): ACCESS PSYCHIATRY OF CT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2022
Last Update Date: 03/21/2022
Certification Date: 03/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2068 BRIDGEPORT AVE STE D
MILFORD CT
06460-4634
US

IV. Provider business mailing address

5 CAMDEN PL
NEW HYDE PARK NY
11040-3601
US

V. Phone/Fax

Practice location:
  • Phone: 516-582-1948
  • Fax:
Mailing address:
  • Phone: 516-582-1948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ANANTHAKUMAR THILLAINATHAN
Title or Position: MD
Credential: MD
Phone: 516-582-1948