Provider Demographics
NPI:1730956293
Name:RECOVER UNDERCOVER LLC
Entity type:Organization
Organization Name:RECOVER UNDERCOVER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:RANDOLPH
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:631-546-8849
Mailing Address - Street 1:1600 CALEBS PATH EXT STE 122
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-5224
Mailing Address - Country:US
Mailing Address - Phone:631-994-1075
Mailing Address - Fax:631-350-0293
Practice Address - Street 1:1600 CALEBS PATH EXT STE 122
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-5224
Practice Address - Country:US
Practice Address - Phone:631-994-1075
Practice Address - Fax:631-350-0293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-05
Last Update Date:2025-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No177F00000XOther Service ProvidersLodgingGroup - Single Specialty