Behavioral Health Medical Practice P.C.
Organization Active NPI Specialist · East Patchogue, NY
NPI 1033232467 · NPPES record last updated Aug 20, 2021
Key facts
- NPI
- 1033232467
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Specialist 174400000X
- License
- 227462 (NY)
- Legal business name
- BEHAVIORAL HEALTH MEDICAL PRACTICE P.C.
- Practice address
- 240 Patchogue Yaphank Rd
Suite 211
East Patchogue, NY 11772-4868 - Phone
- (631) 758-2815
- Fax
- (631) 206-9299
- NPI assigned
- Apr 9, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Moataz Yousef Haggag, M.D.
- Title
- President
- Phone
- (631) 758-2815
Practitioners 5
-
Joanne M Della Valle, LCSW
-
Moataz Yousef Haggag, M.D.
-
Fahim U Qureshi, MD
-
Sharon Fay Solina, LCSW
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20071005000275 | NY | Part B Supplier - Clinic/Group Practice | 7113012196 |
Receives reassigned benefits from 2 practitioners Practice locations: East Patchogue, NY; Dix Hills, NY |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist |
174400000X | 227462 | NY | Yes |
Addresses
Primary practice location
240 Patchogue Yaphank Rd
Suite 211
East Patchogue, NY 11772-4868
Mailing address
110 Fig Dr
Dix Hills, NY 11746-5657
Phone (631) 758-2815
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02986065 | Medicaid | NY |
Other providers in East Patchogue, NY
- Stephanie Basant
- Jessica Bass
- Karen L Bath
- Audrey Annmarie Beckford
- Rebecka Abigail Beckles
- David Belli
- Marion J Bergman
- Hasan I Berisha
- Richard E Berman
- Gopal A Bhandarkar
All providers in East Patchogue, NY · Specialist in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 20, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.