Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.

Shore to Shore Psychiatry PC

Organization Psychiatry Physician · NPI 1508624990

Shore to Shore Psychiatry PC provides Psychiatry Physician services in Port Jefferson Station, New York. Registered with an NPI since 2024.

In the registry since
2024
What do these letters mean?
PC — Professional corporation
A form of business registration, not a clinical qualification.

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Practice location Address checks out

1660 Route 112 # C1
Port Jefferson Station, NY 11776-8057
Phone: (631) 403-6917
Fax: (631) 938-1006
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychiatry Physician (primary) Taxonomy 2084P0800X

Record details

NPI number1508624990
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Robert Glenn — Owner · (631) 403-6917
NPI enumeratedMarch 11, 2024
Last updated in NPPESMarch 11, 2024
Certification dateMarch 10, 2024
Mailing address1660 Route 112 # C1, Port Jefferson Station, NY 11776-8057

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