Healthcare Provider Details

I. General information

NPI: 1689510372
Provider Name (Legal Business Name): NUMBER OF THIS NOTICE: CP 575 G NURSE PRACTITIONER IN PSYCHIATRY CARE FOR WOMEN 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

101 HILLSIDE AVE STE 101
WILLISTON PARK NY
11596-2347
US

IV. Provider business mailing address

36 FLAMINGO RD N
ROSLYN NY
11576-2606
US

V. Phone/Fax

Practice location:
  • Phone: 516-231-2771
  • Fax: 516-531-8931
Mailing address:
  • Phone: 516-697-1682
  • Fax: 516-531-8931

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: MRS. ANTHONY BARISANO
Title or Position: PSYCHIATRIC NURSE PRACTITIONER
Credential: PMHNP-BC
Phone: 516-697-1682