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General NPI Number Information
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NPI Number | 1124312566
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Entity Type | Organization
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Legal Business Name | SUFFOLK BEHAVIORAL MEDICINE P.C
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Dates
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Enumeration Date | 06/02/2011
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Last Update Date | 03/07/2013
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Provider Practice Location Address
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Address Line | 535 BROADHOLLOW RD
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City | MELVILLE
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State | NY
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Zip | 11747-3713
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Country | US
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Telephone | 631-513-6262
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Fax |
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Provider Business Mailing Address
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Address Line | 535 BROAD HOLLOW ROAD SUITE B-12
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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 | 631-513-6262
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. MULCHAND CHUGH
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Credential | M.D.
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Telephone | 631-513-6262
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 245951
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License Number State | NY
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