Healthcare Provider Details

I. General information

NPI: 1124952817
Provider Name (Legal Business Name): PURE MIND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3630 HILL BLVD STE 102
JEFFERSON VALLEY NY
10535-1503
US

IV. Provider business mailing address

3630 HILL BLVD STE 102
JEFFERSON VALLEY NY
10535-1503
US

V. Phone/Fax

Practice location:
  • Phone: 914-432-1065
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: FISHEL SOFER
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 914-432-4065