Provider Demographics
NPI:1487245544
Name:HOPE PSYCHIATRIC WELLNESS SERVICES P.C.
Entity type:Organization
Organization Name:HOPE PSYCHIATRIC WELLNESS SERVICES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MASTAN
Authorized Official - Middle Name:REDDY
Authorized Official - Last Name:LOKIREDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-616-0648
Mailing Address - Street 1:864 THIRD AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:11010-1829
Mailing Address - Country:US
Mailing Address - Phone:516-616-0648
Mailing Address - Fax:
Practice Address - Street 1:864 THIRD AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN SQUARE
Practice Address - State:NY
Practice Address - Zip Code:11010-1829
Practice Address - Country:US
Practice Address - Phone:516-616-0648
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-01
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1124431440Medicaid