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General NPI Number Information
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NPI Number | 1063358711
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Entity Type | Organization
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Legal Business Name | FURTHER NURSE PRACTITIONER IN PSYCHIATRY PRACTICE PLLC
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Dates
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Enumeration Date | 04/27/2026
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Last Update Date | 04/27/2026
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Provider Practice Location Address
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Address Line | 609 ROUTE 109 STE 2D
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City | WEST BABYLON
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State | NY
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Zip | 11704-5000
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Country | US
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Telephone | 631-318-4490
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Fax | 631-983-6132
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Provider Business Mailing Address
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Address Line | 445 BROAD HOLLOW RD SUITE 25 #40
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City | MELVILLE
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State | NY
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Zip | 11747
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Country | US
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Telephone | 631-318-4490
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Fax | 631-983-6132
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Authorized Official
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Title or Position | OWNER/MANAGING MEMBER
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Name | MICHAEL M TOBIN
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Credential | PMHNP-BC
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Telephone | 631-318-4490
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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