Healthcare Provider Details

I. General information

NPI: 1659234334
Provider Name (Legal Business Name): WILLIAMSBURG NURSE PRACTITIONER IN PSYCHIATRY AND FAMILY HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 KENT AVE KRS 20
BROOKLYN NY
11249
US

IV. Provider business mailing address

9456 SPRINGFIELD BLVD
QUEENS VILLAGE NY
11428-2146
US

V. Phone/Fax

Practice location:
  • Phone: 646-580-0723
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: HAO CHAU
Title or Position: CEO
Credential: NP
Phone: 646-580-0723