Provider Demographics
NPI:1558489864
Name:NORTH SHORE PSYCHIATRIC CONSULTANTS PC
Entity type:Organization
Organization Name:NORTH SHORE PSYCHIATRIC CONSULTANTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEGORTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-915-9207
Mailing Address - Street 1:180 E MAIN ST STE 302
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2811
Mailing Address - Country:US
Mailing Address - Phone:631-265-6868
Mailing Address - Fax:631-265-6890
Practice Address - Street 1:180 E MAIN ST STE 302
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2811
Practice Address - Country:US
Practice Address - Phone:631-265-6868
Practice Address - Fax:631-265-6890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00981388Medicaid
NY00981388Medicaid