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Organization
SHORE TO SHORE PSYCHIATRY P.C.
Active
Organization
SHORE TO SHORE PSYCHIATRY P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT C GLENN MD (OWNER)
(631) 403-6917
Entity
Organization
Contact information
Practice address
1660 ROUTE 112 # C1, PORT JEFFERSON STATION, NY 11776-8057
(631) 403-6917
(631) 938-1006
Mailing address
1660 ROUTE 112 # C1, PORT JEFFERSON STATION, NY 11776-8057
(631) 403-6917
(631) 938-1006
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
319049-01
MEDICAL LICENSE
NY
Enumeration date
03/11/2024
Last updated
03/11/2024
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