1083718779 NPI number — SOUTHEAST NASSAU GUIDANCE CENTER INC.

Table of content: (NPI 1083718779)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083718779 NPI number — SOUTHEAST NASSAU GUIDANCE CENTER INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHEAST NASSAU GUIDANCE CENTER INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083718779
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/23/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2146 JACKSON AVE
Provider Second Line Business Mailing Address:
P.O. BOX 1037
Provider Business Mailing Address City Name:
SEAFORD
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11783-2606
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-221-3030
Provider Business Mailing Address Fax Number:
516-221-4160

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2146 JACKSON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEAFORD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11783-2606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-221-3030
Provider Business Practice Location Address Fax Number:
516-221-1013
Provider Enumeration Date:
09/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MIRABELLA
Authorized Official First Name:
ROSALIA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
516-221-3030

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  6801100A , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com