=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891067294
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WINGSPAN PSYCHIATRIC, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2012
-----------------------------------------------------
Last Update Date | 10/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 138 S COLUMBUS AVE FL 1
-----------------------------------------------------
City | MOUNT VERNON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10553-1337
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-701-3285
-----------------------------------------------------
Fax | 978-701-6001
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 101 ELLWOOD AVE APT 4A
-----------------------------------------------------
City | MOUNT VERNON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10552-3428
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-413-1553
-----------------------------------------------------
Fax | 917-791-8239
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING SOLE OWNER
-----------------------------------------------------
Name | FRANCIS FITZGERALD HAYDEN II
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 914-413-1553
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 189845
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------