Shore to Shore Psychiatry P.C.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

SHORE TO SHORE PSYCHIATRY P.C.

Practice address

1660 Route 112 # C1
Port Jefferson Station, NY 11776-8057

Phone

(631) 403-6917

Fax

(631) 938-1006

NPI assigned

Mar 11, 2024

Last updated

Mar 11, 2024By 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

Mr. Robert C Glenn, MDNPI 1902033210

Title

Owner

Phone

(631) 403-6917

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Shore to Shore Psychiatry PC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Shore to Shore Psychiatry P.C.

  • Psychiatry Physician
  • Port Jefferson Station, NY
  • NPI 1558129932
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Robert Clifton Glenn, MD

  • Psychiatry Physician
  • Redlands, CA
  • NPI 1902033210
  NPD (past) Authorized official

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

{
    "created_epoch": "1710115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710115200000",
    "number": "1508624990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1660 ROUTE 112 # C1",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117768057",
            "telephone_number": "631-403-6917",
            "fax_number": "631-938-1006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1660 ROUTE 112 # C1",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117768057",
            "telephone_number": "631-403-6917",
            "fax_number": "631-938-1006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHORE TO SHORE PSYCHIATRY P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-11",
        "last_updated": "2024-03-11",
        "certification_date": "2024-03-10",
        "status": "A",
        "authorized_official_last_name": "GLENN",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "631-403-6917",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "319049-01",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gerald Shephard, LCSW
• William Hy Sher, M.D.
• Raakhee Nagesh Shirsat, RPH, CDM
• Victoria Shklar, MD
• Shore to Shore Medical Wellness PLLC
• Shore to Shore Psychiatry P.C.
• Mary Margaret Siano, LMT
• Suzanne Simeone, LMHC
• Sheprica Simpson
• Troy Simpson

• Psychiatry Physician in Port Jefferson Station, NY
• Providers in Port Jefferson Station, NY by specialty
• Psychiatry Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2024; 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.