1386851038 NPI number — BEHAVIORAL MEDICINE & BIOFEEDBACK SERVICES, P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386851038 NPI number — BEHAVIORAL MEDICINE & BIOFEEDBACK SERVICES, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEHAVIORAL MEDICINE & BIOFEEDBACK SERVICES, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386851038
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1212 N COUNTRY RD
Provider Second Line Business Mailing Address:
SUITE 4B
Provider Business Mailing Address City Name:
STONY BROOK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11790-1919
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-689-1300
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1212 N COUNTRY RD
Provider Second Line Business Practice Location Address:
SUITE 4B
Provider Business Practice Location Address City Name:
STONY BROOK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11790-1919
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-689-1300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MARGOLIS
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
H
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
631-689-1300

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  151667 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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