Southside Hospital Department of Psychiatry

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

SOUTHSIDE HOSPITAL DEPARTMENT OF PSYCHIATRY

Practice address

301 E Main St
Bay Shore, NY 11706-8408

Phone

(631) 675-4149

NPI assigned

Apr 26, 2006

Organization subpart

Yes

Parent organization

SOUTHSIDE HOSPITALAs reported in NPPES

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

Authorized official

Name

Ms. Winifred B. Mack

Title

Executive Director

Phone

(631) 968-9000

Specialties & licenses 3

Addresses

Other identifiers 1

Part of

Southside Hospital HHA

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

{
    "created_epoch": "1146009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1218585600000",
    "number": "1881650869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 E MAIN ST",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117068408",
            "telephone_number": "631-675-4149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 E MAIN ST",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117068408",
            "telephone_number": "631-675-4149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHSIDE HOSPITAL DEPARTMENT OF PSYCHIATRY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHSIDE HOSPITAL",
        "enumeration_date": "2006-04-26",
        "last_updated": "2008-08-13",
        "status": "A",
        "authorized_official_last_name": "MACK",
        "authorized_official_first_name": "WINIFRED",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "631-968-9000",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0805X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Geriatric Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01785395",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Southside Hospital
• Southside Hospital
• Southside Hospital Department of Cardiology
• Southside Hospital Department of Neurology
• Southside Hospital Department of Pathology
• Southside Hospital Emergency Department
• Southside Hospital Faculty Practice
• Jaclyn Spiegel, PSY.D.
• Rex Spielmann, MD
• Richard Frank Spinello

• Psychiatry Physician in Bay Shore, NY
• Providers in Bay Shore, 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 Aug 13, 2008; 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.