Provider Demographics
NPI:1699364281
Name:REGIONAL NP IN PSYCHIATRY
Entity type:Organization
Organization Name:REGIONAL NP IN PSYCHIATRY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:W
Authorized Official - Last Name:CILIONE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:646-452-8200
Mailing Address - Street 1:170 HALPIN AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-1227
Mailing Address - Country:US
Mailing Address - Phone:646-452-8200
Mailing Address - Fax:646-452-8202
Practice Address - Street 1:170 HALPIN AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-1227
Practice Address - Country:US
Practice Address - Phone:464-528-2006
Practice Address - Fax:646-452-8202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-18
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1265586168OtherCAQH