Healthcare Provider Details

I. General information

NPI: 1396997672
Provider Name (Legal Business Name): CATHERINE POULOS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2008
Last Update Date: 01/08/2023
Certification Date: 01/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

332 W MONTAUK HWY STE 5
HAMPTON BAYS NY
11946-3551
US

IV. Provider business mailing address

332 W MONTAUK HWY STE 5
HAMPTON BAYS NY
11946-3551
US

V. Phone/Fax

Practice location:
  • Phone: 631-495-3300
  • Fax: 631-822-2833
Mailing address:
  • Phone: 631-495-3300
  • Fax: 631-822-2833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF-401489
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: