Healthcare Provider Details

I. General information

NPI: 1598397044
Provider Name (Legal Business Name): LONG ISLAND CHILD & ADOLESCENT PSYCHIATRY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2020
Last Update Date: 02/12/2020
Certification Date: 02/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 ROUTE 111 STE 101
SMITHTOWN NY
11787-3700
US

IV. Provider business mailing address

40 VARSITY BLVD
EAST SETAUKET NY
11733-1070
US

V. Phone/Fax

Practice location:
  • Phone: 631-388-3505
  • Fax: 631-364-9379
Mailing address:
  • Phone: 631-804-7542
  • Fax: 631-364-9379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. DAVID M MARGULIES
Title or Position: PRESIDENT
Credential: MD
Phone: 631-388-3505