NPIMap

Organization Active NPI

Ny Ketamine Medical Practice PLLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • New York, NY
National Provider Identifier
1073496402
Registry record updated Jun 3, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
NY KETAMINE MEDICAL PRACTICE PLLC
Practice address
160 Broadway FL 16
New York, NY 10038-4207
Phone
(917) 261-7370
Fax
(917) 477-6421
NPI assigned
Jul 31, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Heather Okeefe
Title
Chief Financial Officer
Phone
(509) 994-1345

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

160 Broadway FL 16
New York, NY 10038-4207

Mailing address

PO Box 32
Woodlawn, TN 37191-0032
Phone (917) 261-7370

Other practice location 1

150 Broadhollow Rd Ste 103
Melville, NY 11747-4901
Phone (917) 261-7370

Other names 1

  • NY Ketamine Medical Practice Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20251224000180 NY Part B Supplier - Clinic/Group Practice 0244725539 Receives reassigned benefits from 7 practitioners
Practice locations: Melville, NY; New York, NY

National Provider Directory

National Provider Directory

Locations

150 Broadhollow Rd
Ste 103
Melville, NY 11747
Phone (631) 629-4626

75 Maiden Ln
Fl 10
New York, NY 10038
Phone (917) 261-7370

160 Broadway
Fl 16
New York, NY 10038
Phone (212) 920-7833

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1753920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1780444800000",
    "number": "1073496402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 32",
            "city": "WOODLAWN",
            "state": "TN",
            "postal_code": "371910032",
            "telephone_number": "917-261-7370",
            "fax_number": "917-477-6421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 BROADWAY FL 16",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100384207",
            "telephone_number": "917-261-7370",
            "fax_number": "917-477-6421"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "150 Broadhollow Rd Ste 103",
            "address_purpose": "LOCATION",
            "city": "Melville",
            "state": "NY",
            "postal_code": "117474901",
            "country_code": "US",
            "telephone_number": "917-261-7370",
            "fax_number": "917-477-6421",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NY KETAMINE MEDICAL PRACTICE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-07-31",
        "last_updated": "2026-06-03",
        "certification_date": "2026-06-03",
        "status": "A",
        "authorized_official_last_name": "OKEEFE",
        "authorized_official_first_name": "HEATHER",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "509-994-1345"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NY Ketamine Medical Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.