Healthcare Provider Details

I. General information

NPI: 1629438726
Provider Name (Legal Business Name): SAFE HARBOR PSYCHIATRIC SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2016
Last Update Date: 03/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

978 ROUTE 45 SUITE 203
POMONA NY
10970-3521
US

IV. Provider business mailing address

PO BOX 482
POMONA NY
10970-0482
US

V. Phone/Fax

Practice location:
  • Phone: 845-364-8221
  • Fax: 845-364-8221
Mailing address:
  • Phone: 845-364-8221
  • Fax: 845-364-8221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: GEORGE L. NODARSE
Title or Position: OWNER
Credential: M.D.
Phone: 201-923-5099