Healthcare Provider Details

I. General information

NPI: 1376409706
Provider Name (Legal Business Name): HOLISTIC MINDS PSYCHIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2025
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 FRANKEL BLVD
MERRICK NY
11566-4796
US

IV. Provider business mailing address

215 FRANKEL BLVD
MERRICK NY
11566-4796
US

V. Phone/Fax

Practice location:
  • Phone: 516-528-5186
  • Fax:
Mailing address:
  • Phone: 516-528-5186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: EDLINE ANTOINE
Title or Position: OWNER
Credential:
Phone: 516-528-5186