Healthcare Provider Details

I. General information

NPI: 1609249754
Provider Name (Legal Business Name): ISLAND PSYCHIATRY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2015
Last Update Date: 05/16/2026
Certification Date: 05/16/2026
Deactivation Date: 01/10/2024
Reactivation Date: 01/30/2024

III. Provider practice location address

200 BELLE TERRE RD
PORT JEFFERSON NY
11777-1968
US

IV. Provider business mailing address

200 BELLE TERRE RD
PORT JEFFERSON STATION NY
11777-1968
US

V. Phone/Fax

Practice location:
  • Phone: 631-474-6000
  • Fax:
Mailing address:
  • Phone: 631-474-6000
  • Fax: 888-506-5997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State

VIII. Authorized Official

Name: RANDALL SOLOMON
Title or Position: OWNER
Credential: M.D.
Phone: 631-474-8099