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General NPI Number Information
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NPI Number | 1609249754
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Entity Type | Organization
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Legal Business Name | ISLAND PSYCHIATRY, P.C.
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Dates
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Enumeration Date | 11/10/2015
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Last Update Date | 01/30/2024
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Provider Practice Location Address
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Address Line | 55 NESCONSET HWY
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City | PORT JEFFERSON STATION
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State | NY
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Zip | 11776-2631
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Country | US
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Telephone | 631-474-8099
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Fax | 888-506-5997
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Provider Business Mailing Address
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Address Line | 55 NESCONSET HWY
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City | PORT JEFFERSON STATION
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State | NY
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Zip | 11776-2631
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Country | US
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Telephone | 631-474-8099
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Fax | 888-506-5997
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Authorized Official
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Title or Position | OWNER
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Name | RANDALL SOLOMON
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Credential | M.D.
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Telephone | 631-474-8099
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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 | 274017
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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 | 174711
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License Number State | NY
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