Provider Demographics
NPI:1104072677
Name:LONG ISLAND BEHAVIORAL MEDICINE PC
Entity type:Organization
Organization Name:LONG ISLAND BEHAVIORAL MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:DOWLING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-265-0909
Mailing Address - Street 1:1727 VETERANS MEMORIAL HWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-1520
Mailing Address - Country:US
Mailing Address - Phone:631-656-0472
Mailing Address - Fax:631-656-0634
Practice Address - Street 1:1727 VETERANS MEMORIAL HWY
Practice Address - Street 2:SUITE 300
Practice Address - City:ISLANDIA
Practice Address - State:NY
Practice Address - Zip Code:11749-1520
Practice Address - Country:US
Practice Address - Phone:631-656-0472
Practice Address - Fax:631-656-0634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-14
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1837312084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherTAX ID NUMBER