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General NPI Number Information
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NPI Number | 1669096699
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Entity Type | Organization
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Legal Business Name | PRESERVING HEALTHY MINDS, NURSE PRACTITIONER OF PSYCHIATRY PLLC
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Dates
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Enumeration Date | 06/05/2020
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Last Update Date | 01/16/2024
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Provider Practice Location Address
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Address Line | 493 SHODDY HOLLOW RD
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City | MIDDLETOWN
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State | NY
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Zip | 10940-7509
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Country | US
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Telephone | 845-386-9979
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 673
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City | HOWELLS
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State | NY
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Zip | 10932-0673
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Country | US
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Telephone | 718-704-9974
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER OF PSYCHIATRY
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Name | SARON FONG
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Credential | PMHNP-BC
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Telephone | 718-704-9974
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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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