Healthcare Provider Details

I. General information

NPI: 1962125799
Provider Name (Legal Business Name): EM MEDICAL NY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2022
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 HEMPSTEAD TPKE STE 403
LEVITTOWN NY
11756-1396
US

IV. Provider business mailing address

PO BOX 102904
PASADENA CA
91189-0140
US

V. Phone/Fax

Practice location:
  • Phone: 406-219-7835
  • Fax:
Mailing address:
  • Phone: 866-434-1632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: CHARIE BRYANT
Title or Position: VP, RCM
Credential:
Phone: 803-955-6655