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General NPI Number Information
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NPI Number | 1396607040
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Entity Type | Organization
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Legal Business Name | PHOENIX NURSE PRACTITIONERS IN PSYCHIATRY, PLLC
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Dates
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Enumeration Date | 12/02/2025
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 732 SMITHTOWN BYP STE 206
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City | SMITHTOWN
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State | NY
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Zip | 11787-5020
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Country | US
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Telephone | 631-986-0388
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Fax | 866-598-0217
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Provider Business Mailing Address
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Address Line | 3 BAYLOR DR
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City | SMITHTOWN
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State | NY
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Zip | 11787-2001
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Country | US
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Telephone | 631-986-0388
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Fax | 866-598-0217
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Authorized Official
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Title or Position | OWNER
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Name | DR. JANINE DESIMONE
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Credential | PMHNP-BC
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Telephone | 631-921-1949
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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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