MEDICARE: OPERATION ENGAGE PSYCHIATRIC SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1740071182
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPERATION ENGAGE PSYCHIATRIC SERVICES

Provider Business Mailing Address
First Line	:	39 WOODBURY RD
Second Line	:
City	:	FARMINGVILLE
State	:	NY
Zip	:	11738-2318
Country	:	US
Telephone Number	:	631-317-2872
Fax Number	:	661-241-9567

Provider Business Practice Location Address
First Line	:	1641 ROUTE 112 STE C
Second Line	:
City	:	MEDFORD
State	:	NY
Zip	:	11763-3663
Country	:	US
Telephone Number	:	631-730-5457
Fax Number	:	631-803-4242

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	KAREN NELSON
Credential	:
Telephone Number	:	631-317-2872

Provider Enumeration Date	:	05/15/2025
Last Update Date	:	08/04/2025

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