Healthcare Provider Details

I. General information

NPI: 1568880771
Provider Name (Legal Business Name): LONG ISLAND CHILD PSYCHIATRY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2014
Last Update Date: 04/03/2014
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 TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number248588
License Number StateNY

VIII. Authorized Official

Name: DR. JAMES TOWNSEND
Title or Position: MANAGING MEMBER
Credential: D.O.
Phone: 631-343-3140