| The Family Tree Psychiatric & Medical Services | |
|
5225 Nesconset Hwy Ste 46 Port Jefferson Station NY 11776-2060 | |
| (631) 209-1477 | |
| (631) 744-3246 |
| Full Name | The Family Tree Psychiatric & Medical Services |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 5225 Nesconset Hwy Ste 46, Port Jefferson Station, New York |
| Authorized Official Name and Position | Robert Daniel Colucci (PRESIDENT) |
| Authorized Official Contact | 6312091477 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| The Family Tree Psychiatric & Medical Services 70 Cobblestone Dr Shoreham NY 11786-2359 Ph: (631) 209-1477 | The Family Tree Psychiatric & Medical Services 5225 Nesconset Hwy Ste 46 Port Jefferson Station NY 11776-2060 Ph: (631) 209-1477 |
| NPI Number | 1427238005 |
|---|---|
| Provider Enumeration Date | 11/12/2007 |
| Last Update Date | 11/12/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427238005 | NPI | - | NPPES |
| 02916365 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 199981 (New York) | Primary |
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