| Positive Change Psychiatry Pllc | |
|
175 Jericho Tpke Suite 301 Syosset NY 11791-4532 | |
| (516) 364-6500 | |
| (631) 465-9336 |
| Full Name | Positive Change Psychiatry Pllc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 175 Jericho Tpke, Syosset, New York |
| Authorized Official Name and Position | Kamil Atta (OWNER) |
| Authorized Official Contact | 5163646500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Positive Change Psychiatry Pllc 220 Forest Dr Jericho NY 11753-2320 Ph: (516) 364-6500 | Positive Change Psychiatry Pllc 175 Jericho Tpke Suite 301 Syosset NY 11791-4532 Ph: (516) 364-6500 |
| NPI Number | 1265821953 |
|---|---|
| Provider Enumeration Date | 01/18/2015 |
| Last Update Date | 01/18/2015 |
| Medicare PECOS PAC ID | 7517285455 |
|---|---|
| Medicare Enrollment ID | O20150406001187 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265821953 | NPI | - | NPPES |
| 02896459 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 242083 (New York) | Primary |
| Provider Name | Kamil Atta |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1326269093 PECOS PAC ID: 3577652023 Enrollment ID: I20071205000586 |
| Provider Name | Carole R Capparelli |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083790364 PECOS PAC ID: 0345306353 Enrollment ID: I20090226000566 |
| Provider Name | Samantha Palladino |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225693807 PECOS PAC ID: 0143558163 Enrollment ID: I20190828002238 |
| Provider Name | Crystal Nevins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801047469 PECOS PAC ID: 0345651949 Enrollment ID: I20201203001841 |
| Provider Name | Tijuana Temple |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881369486 PECOS PAC ID: 2466843990 Enrollment ID: I20211216002940 |
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