Healthcare Provider Details

I. General information

NPI: 1497973226
Provider Name (Legal Business Name): JAMES EDWARD TOWNSEND D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 11/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S JERSEY AVE UNIT #1
EAST SETAUKET NY
11733-2034
US

IV. Provider business mailing address

100 S JERSEY AVE UNIT #1
EAST SETAUKET NY
11733-2034
US

V. Phone/Fax

Practice location:
  • Phone: 631-343-3140
  • Fax: 631-343-3124
Mailing address:
  • Phone: 631-343-3140
  • Fax: 631-343-3124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MB07807200
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number248588
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: