Provider Demographics
NPI:1528946829
Name:EMERGING PATH NURSE PRACTITIONER IN PSYCHIATRY, PC
Entity type:Organization
Organization Name:EMERGING PATH NURSE PRACTITIONER IN PSYCHIATRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:DANTONIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-629-2879
Mailing Address - Street 1:315 WALT WHITMAN RD STE 210
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-4112
Mailing Address - Country:US
Mailing Address - Phone:631-629-2879
Mailing Address - Fax:949-864-3515
Practice Address - Street 1:315 WALT WHITMAN RD STE 210
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-4112
Practice Address - Country:US
Practice Address - Phone:631-629-2879
Practice Address - Fax:949-864-3515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-25
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty