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General NPI Number Information
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NPI Number | 1982021440
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Entity Type | Organization
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Legal Business Name | SOUTHERN DUTCHESS PSYCHIATRIC CONSULTATION PLLC
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Dates
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Enumeration Date | 03/23/2014
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Last Update Date | 06/16/2014
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Provider Practice Location Address
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Address Line | 1285 ROUTE 9 SUITE #7
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City | WAPPINGERS FALLS
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State | NY
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Zip | 12590-4993
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Country | US
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Telephone | 845-632-2939
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Fax | 845-632-2940
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Provider Business Mailing Address
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Address Line | 26 FIREMENS MEMORIAL DR 115
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City | POMONA
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State | NY
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Zip | 10970-3553
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Country | US
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Telephone | 800-750-8616
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Fax | 845-362-8474
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Authorized Official
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Title or Position | OWNER
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Name | MR. PE-SHEIN WYNN
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Credential | MD
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Telephone | 800-750-8616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084B0040X
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Taxonomy Name | Behavioral Neurology & Neuropsychiatry Physician
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License Number | A208505-1
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License Number State | NY
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