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General NPI Number Information
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NPI Number | 1437474137
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Entity Type | Organization
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Legal Business Name | NORTH FORK PSYCHIATRY, PLLC
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Dates
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Enumeration Date | 04/06/2010
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Last Update Date | 04/06/2010
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Provider Practice Location Address
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Address Line | 300 ATLANTIC AVE
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City | GREENPORT
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State | NY
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Zip | 11944-1264
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Country | US
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Telephone | 631-627-1559
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Fax | 621-477-0219
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Provider Business Mailing Address
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Address Line | 300 ATLANTIC AVE
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City | GREENPORT
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State | NY
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Zip | 11944-1264
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Country | US
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Telephone | 631-627-1559
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Fax | 621-477-0219
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Authorized Official
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Title or Position | CEO, EXECUTIVE CHAIRMAN
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Name | DOUGLAS K HOVERKAMP
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Credential | M.D., ABPN
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Telephone | 631-627-1559
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 247356
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 247356
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License Number State | NY
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