| Behavioral Enhancement & Substance Abuse Medicine Treatment Pllc | |
|
770 Grand Blvd Suite 17 Deer Park NY 11729-5750 | |
| (631) 392-4357 | |
| (631) 392-4358 |
| Full Name | Behavioral Enhancement & Substance Abuse Medicine Treatment Pllc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 770 Grand Blvd, Deer Park, New York |
| Authorized Official Name and Position | Deborah M. Petry (PROGRAM SUPERVISOR) |
| Authorized Official Contact | 6313924357 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Behavioral Enhancement & Substance Abuse Medicine Treatment Pllc 770 Grand Blvd Suite 17 Deer Park NY 11729-5750 Ph: (631) 392-4357 | Behavioral Enhancement & Substance Abuse Medicine Treatment Pllc 770 Grand Blvd Suite 17 Deer Park NY 11729-5750 Ph: (631) 392-4357 |
| NPI Number | 1346680071 |
|---|---|
| Provider Enumeration Date | 06/26/2013 |
| Last Update Date | 12/04/2013 |
| Medicare PECOS PAC ID | 9436382777 |
|---|---|
| Medicare Enrollment ID | O20140512001557 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346680071 | NPI | - | NPPES |
| 140511797 | Other | NY | OASAS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 140511797 (New York) | Primary |
| Provider Name | Tomrul E Tuzel |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1609898246 PECOS PAC ID: 9032391420 Enrollment ID: I20110307000302 |
| Provider Name | Mary Alice Dowling |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518477033 PECOS PAC ID: 8628454089 Enrollment ID: I20221007002655 |
| Provider Name | Tina Krishnarao |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1689022105 PECOS PAC ID: 2062873235 Enrollment ID: I20240227001105 |
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