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General NPI Number Information
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NPI Number | 1043562986
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Entity Type | Organization
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Legal Business Name | HOPE TMS MEDICAL PRACTICE PC
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Dates
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Enumeration Date | 10/02/2012
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Last Update Date | 10/02/2012
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Provider Practice Location Address
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Address Line | 646 MAIN ST SUITE 201
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City | PORT JEFFERSON
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State | NY
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Zip | 11777-2235
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Country | US
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Telephone | 631-509-6111
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Fax | 631-509-6112
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Provider Business Mailing Address
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Address Line | 646 MAIN ST SUITE 201
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City | PORT JEFFERSON
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State | NY
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Zip | 11777-2235
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Country | US
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Telephone | 631-509-6111
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Fax | 631-509-6112
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. RENA K FERGUSON
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Credential | M.D.
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Telephone | 631-509-6111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 230330
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License Number State | NY
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