Provider Demographics
NPI:1548989429
Name:PECONIC WELLNESS NP - PSYCHIATRY SERVICES PLLC
Entity type:Organization
Organization Name:PECONIC WELLNESS NP - PSYCHIATRY SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:ALLISON
Authorized Official - Last Name:HERTWIG
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:631-873-9257
Mailing Address - Street 1:15 W MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:HAMPTON BAYS
Mailing Address - State:NY
Mailing Address - Zip Code:11946-4001
Mailing Address - Country:US
Mailing Address - Phone:631-873-9257
Mailing Address - Fax:
Practice Address - Street 1:35 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:QUOGUE
Practice Address - State:NY
Practice Address - Zip Code:11959-4000
Practice Address - Country:US
Practice Address - Phone:631-873-9257
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-24
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty