Healthcare Provider Details

I. General information

NPI: 1497199707
Provider Name (Legal Business Name): PILGRIM PSYCHIATRIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2013
Last Update Date: 04/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

998 CROOKED HILL RD
WEST BRENTWOOD NY
11717-1019
US

IV. Provider business mailing address

998 CROOKED HILL RD
WEST BRENTWOOD NY
11717-1019
US

V. Phone/Fax

Practice location:
  • Phone: 631-761-3500
  • Fax:
Mailing address:
  • Phone: 631-761-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number302ROOOOOX
License Number StateNY

VIII. Authorized Official

Name: SEIDELL NEIZA POINDEXTER
Title or Position: INTENSIVE CASE MANAGER
Credential: MS CRC LMHC
Phone: 516-505-2003