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General NPI Number Information
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NPI Number | 1174727291
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Entity Type | Organization
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Legal Business Name | ISLAND WIDE PSYCHIATRIC SERVICES PC
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Dates
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Enumeration Date | 06/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 327 BCH 19 ST
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City | FAR ROCKAWAY
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State | NY
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Zip | 11691
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Country | US
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Telephone | 516-869-7250
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Fax |
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Provider Business Mailing Address
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Address Line | 180 ALDEN RD
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City | WOODMERE
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State | NY
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Zip | 11598-1810
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Country | US
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Telephone | 516-374-4671
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | HARSHA VARDHAN REDDY
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Credential | MD
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Telephone | 516-374-4671
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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 |
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License Number State |
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