1396690467 NPI number — NURTURE MIND NP IN PSYCHIATRY, P.C.

Table of content: (NPI 1396690467)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396690467 NPI number — NURTURE MIND NP IN PSYCHIATRY, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NURTURE MIND NP IN PSYCHIATRY, P.C.
Provider Last Name:
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Provider Middle Name:
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Provider's Other Name Information

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NPI Number Information

NPI Number:
1396690467
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/21/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7 GATES AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLAINVIEW
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11803-5911
Provider Business Mailing Address Country Code:
US
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Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7 GATES AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLAINVIEW
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11803-5911
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-813-1957
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/03/2026

Additional Information

Authorized Official

Authorized Official Last Name:
SHIMONOV
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
347-813-1957

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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