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5550 Merrick Rd Ste 200 Massapequa NY 11758-6238 | |
| (631) 673-3233 | |
| (631) 673-1314 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 5550 Merrick Rd Ste 200, Massapequa, New York |
| Authorized Official Name and Position | Priyadarshan Bajpayi (OWNER) |
| Authorized Official Contact | 5168080765 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
5550 Merrick Rd Ste 200 Massapequa NY 11758-6238 Ph: (631) 673-3233 | 5550 Merrick Rd Ste 200 Massapequa NY 11758-6238 Ph: (631) 673-3233 |
| NPI Number | 1629534474 |
|---|---|
| Provider Enumeration Date | 02/18/2019 |
| Last Update Date | 04/22/2024 |
| Certification Date | 04/22/2024 |
| Medicare PECOS PAC ID | 6608118179 |
|---|---|
| Medicare Enrollment ID | O20190502001387 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629534474 | NPI | - | NPPES |
| Provider Name | Priyadarshan Bajpayi |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1699087148 PECOS PAC ID: 8527252782 Enrollment ID: I20101101001392 |
| Provider Name | Janet E Poretsky |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1902142805 PECOS PAC ID: 0042536328 Enrollment ID: I20150304000366 |
| Provider Name | Deborah Weiss |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093136228 PECOS PAC ID: 8426465808 Enrollment ID: I20210331002171 |
| Provider Name | Edward Balzer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720763196 PECOS PAC ID: 6507201902 Enrollment ID: I20240226000780 |
| Provider Name | James O'shea |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124380308 PECOS PAC ID: 4284074360 Enrollment ID: I20240507000845 |
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