Provider Demographics
NPI:1669096699
Name:PRESERVING HEALTHY MINDS, NURSE PRACTITIONER OF PSYCHIATRY PLLC
Entity type:Organization
Organization Name:PRESERVING HEALTHY MINDS, NURSE PRACTITIONER OF PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER OF PSYCHIATRY
Authorized Official - Prefix:
Authorized Official - First Name:SARON
Authorized Official - Middle Name:
Authorized Official - Last Name:FONG
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:718-704-9974
Mailing Address - Street 1:PO BOX 673
Mailing Address - Street 2:
Mailing Address - City:HOWELLS
Mailing Address - State:NY
Mailing Address - Zip Code:10932-0673
Mailing Address - Country:US
Mailing Address - Phone:718-704-9974
Mailing Address - Fax:
Practice Address - Street 1:493 SHODDY HOLLOW RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-7509
Practice Address - Country:US
Practice Address - Phone:845-386-9979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-05
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty