GEORGE G. FAIREY MD NPI 1073603734

NPI Information

NPI: 1073603734
Provider Name: GEORGE G. FAIREY MD
Classification: Counselor - 101YM0800X
Entity Type: Organization

Specialization: Mental Health

Address:
1212 N COUNTRY RD STE 2A
STONY BROOK, NY
ZIP 11790
Phone: (631) 689-5155
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GEORGE G. FAIREY MD is a mental health counselor in Stony Brook, NY. GEORGE G. FAIREY MD NPI is 1073603734. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1212 N COUNTRY RD STE 2A
STONY BROOK, NY
ZIP 11790-919
Phone: (631) 689-5155

The provider's authorized official is George G. Fairey .
The authorized official title is Owner and has the following contact phone number (631) 689-5155.

The enumeration date for this NPI number is 10/13/2006 and was last updated on 7/21/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101YM0800X	Counselor	Mental Health	129972	NEW YORK	Yes
2	261QM0850X	Clinic/Center	Adult Mental Health	129972	NEW YORK	X

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	00509146	MEDICAID	NEW YORK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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