The Family Tree Psychiatric & Medical Services

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

199981 Issued in NY

Legal business name

THE FAMILY TREE PSYCHIATRIC & MEDICAL SERVICES

Practice address

5225 Nesconset Hwy Ste 46
Port Jefferson Station, NY 11776-2060

Phone

(631) 209-1477

Fax

(631) 744-3246

NPI assigned

Nov 12, 2007

Last updated

Nov 12, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Robert Daniel Colucci, D.O.

Title

President

Phone

(631) 209-1477

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1194825600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194825600000",
    "number": "1427238005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "70 COBBLESTONE DR",
            "city": "SHOREHAM",
            "state": "NY",
            "postal_code": "117862359",
            "telephone_number": "631-209-1477",
            "fax_number": "631-744-3246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5225 NESCONSET HWY STE 46",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117762060",
            "telephone_number": "631-209-1477",
            "fax_number": "631-744-3246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE FAMILY TREE PSYCHIATRIC & MEDICAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-12",
        "last_updated": "2007-11-12",
        "status": "A",
        "authorized_official_last_name": "COLUCCI",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "DANIEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "631-209-1477",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "199981",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02916365",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Psychiatry Physician in Port Jefferson Station, NY
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• Psychiatry Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.