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Organization
SOUTHSIDE HOSPITAL DEPARTMENT OF PSYCHIATRY
Active
Organization
SOUTHSIDE HOSPITAL DEPARTMENT OF PSYCHIATRY
Active
Parent organization
SOUTHSIDE HOSPITAL
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOUTHSIDE HOSPITAL
Authorized official
MS. WINIFRED B. MACK (EXECUTIVE DIRECTOR)
(631) 968-9000
Entity
Organization
Contact information
Practice address
301 E MAIN ST, BAY SHORE, NY 11706-8408
(631) 675-4149
Mailing address
301 E MAIN ST, BAY SHORE, NY 11706-8408
(631) 675-4149
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
2084P0805X
Geriatric Psychiatry Physician
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01785395
—
NY
Enumeration date
04/26/2006
Last updated
08/13/2008
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