Provider Demographics
NPI:1902252554
Name:CENTRAL PARK SOUTH PSYCHIATRY
Entity Type:Organization
Organization Name:CENTRAL PARK SOUTH PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:CONTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-413-1212
Mailing Address - Street 1:30 CENTRAL PARK S RM 11A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1647
Mailing Address - Country:US
Mailing Address - Phone:646-495-8936
Mailing Address - Fax:646-495-9836
Practice Address - Street 1:30 CENTRAL PARK S RM 11A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1647
Practice Address - Country:US
Practice Address - Phone:646-495-8936
Practice Address - Fax:646-495-9836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-12
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2517922084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03398836Medicaid