| Shore To Shore Psychiatry P.c. | |
|
1660 Route 112 # C1 Port Jefferson Station NY 11776-8057 | |
| (631) 403-6917 | |
| (631) 938-1006 |
| Full Name | Shore To Shore Psychiatry P.c. |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 1660 Route 112 # C1, Port Jefferson Station, New York |
| Authorized Official Name and Position | Robert C Glenn (OWNER) |
| Authorized Official Contact | 6314036917 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Shore To Shore Psychiatry P.c. 1660 Route 112 # C1 Port Jefferson Station NY 11776-8057 Ph: (631) 403-6917 | Shore To Shore Psychiatry P.c. 1660 Route 112 # C1 Port Jefferson Station NY 11776-8057 Ph: (631) 403-6917 |
| NPI Number | 1508624990 |
|---|---|
| Provider Enumeration Date | 03/11/2024 |
| Last Update Date | 03/11/2024 |
| Certification Date | 03/10/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508624990 | NPI | - | NPPES |
| 319049-01 | Other | NY | MEDICAL LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
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