Healthcare Provider Details

I. General information

NPI: 1982364790
Provider Name (Legal Business Name): ADULT HEALTH NURSE PRACTITIONER SERVICES OF THE HAMPTONS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2021
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 MAIN RD
RIVERHEAD NY
11901-1906
US

IV. Provider business mailing address

6 FLOCEE LN
HAMPTON BAYS NY
11946-3006
US

V. Phone/Fax

Practice location:
  • Phone: 845-309-3040
  • Fax: 631-779-2168
Mailing address:
  • Phone: 845-309-3040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SUSAN E MOGAN
Title or Position: OWNER
Credential: DNP, PMHNP, ANP-BC
Phone: 845-309-3040