Individual provider Active NPI

Soumitra Chatterjee, M.D.

  • Psychiatry Physician
  • Holtsville, NY
National Provider Identifier
1285715615
Registry record updated Aug 24, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
229623 Issued in NY
Practice address
69 Spence Ave
Holtsville, NY 11742-1928
Phone
(631) 868-0114
NPI assigned
Oct 19, 2006
Last updated
Aug 24, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 229623 NY Primary

Addresses

Primary practice location

69 Spence Ave
Holtsville, NY 11742-1928

Mailing address

69 Spence Ave
Holtsville, NY 11742-1928
Phone (631) 868-0114

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110407000591 NY Practitioner - Psychiatry 9436333952 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
County of SuffolkGroup PAC ID 2264344316, 8 clinicians

Practice addresses (Care Compare)

15 Horseblock PL
Farmingville, NY 11738-1204
Phone (631) 854-2552

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
229623NYMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Suffolk County Dept of Health Services CurrentSince Mar 3, 2018 Accepting new patients
County of Suffolk Current Accepting new patients
County of Suffolk CurrentSince Mar 3, 2018 Accepting new patients
Alternative Oppurtunities Past Accepting new patients
Nys Office of Mental Health Past Accepting new patients

Locations

1841 Brentwood Rd
Brentwood, NY 11717
Phone (631) 601-1300

15 Horseblock Pl
Farmingville, NY 11738
Phone (631) 854-2552

3500 Sunrise Hwy
Ste 124
Great River, NY 11739
Phone (631) 854-0000

300 Center Dr
Riverhead, NY 11901
Phone (631) 852-1440

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1440374400000",
    "number": "1285715615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "69 SPENCE AVE",
            "city": "HOLTSVILLE",
            "state": "NY",
            "postal_code": "117421928",
            "telephone_number": "631-868-0114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "69 SPENCE AVE",
            "city": "HOLTSVILLE",
            "state": "NY",
            "postal_code": "117421928",
            "telephone_number": "631-868-0114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHATTERJEE",
        "first_name": "SOUMITRA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-19",
        "last_updated": "2015-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "229623",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Holtsville, NY

Sources for this page

Verify at the official NPI Registry.