| Island Psychiatry, P.c. | |
|
55 Nesconset Hwy Port Jefferson Station NY 11776-2631 | |
| (631) 474-8099 | |
| (888) 506-5997 |
| Full Name | Island Psychiatry, P.c. |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 55 Nesconset Hwy, Port Jefferson Station, New York |
| Authorized Official Name and Position | Randall Solomon (OWNER) |
| Authorized Official Contact | 6314748099 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Island Psychiatry, P.c. 55 Nesconset Hwy Port Jefferson Station NY 11776-2631 Ph: (631) 474-8099 | Island Psychiatry, P.c. 55 Nesconset Hwy Port Jefferson Station NY 11776-2631 Ph: (631) 474-8099 |
| NPI Number | 1609249754 |
|---|---|
| Provider Enumeration Date | 11/10/2015 |
| Last Update Date | 01/30/2024 |
| Certification Date | 02/09/2021 |
| Medicare PECOS PAC ID | 9032490610 |
|---|---|
| Medicare Enrollment ID | O20161220001752 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609249754 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 174711 (New York) | Primary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 274017 (New York) | Secondary |
| Provider Name | Randall Solomon |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1780733360 PECOS PAC ID: 8123084431 Enrollment ID: I20041208000830 |
| Provider Name | Kim Miller |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1053319947 PECOS PAC ID: 5597785329 Enrollment ID: I20051123000058 |
| Provider Name | Kathy Junior |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235448424 PECOS PAC ID: 6608108659 Enrollment ID: I20191024002147 |
| Provider Name | Nicole M Kocka |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659047314 PECOS PAC ID: 0840689378 Enrollment ID: I20211122002706 |
| Provider Name | Glenn M Holt |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417444712 PECOS PAC ID: 2567857246 Enrollment ID: I20220316000090 |
| Provider Name | Elizabeth W Raffanello |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1780376251 PECOS PAC ID: 0143680033 Enrollment ID: I20230725000286 |
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