Healthcare Provider Details

I. General information

NPI: 1063358711
Provider Name (Legal Business Name): FURTHER NURSE PRACTITIONER IN PSYCHIATRY PRACTICE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 ROUTE 109 STE 2D
WEST BABYLON NY
11704-5000
US

IV. Provider business mailing address

445 BROAD HOLLOW RD SUITE 25 #40
MELVILLE NY
11747
US

V. Phone/Fax

Practice location:
  • Phone: 631-318-4490
  • Fax: 631-983-6132
Mailing address:
  • Phone: 631-318-4490
  • Fax: 631-983-6132

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: MICHAEL M TOBIN
Title or Position: OWNER/MANAGING MEMBER
Credential: PMHNP-BC
Phone: 631-318-4490