1568459204 NPI number — THE LONG ISLAND HOME

Table of content: (NPI 1568459204)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568459204 NPI number — THE LONG ISLAND HOME

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE LONG ISLAND HOME
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:
SOUTH OAKS HOSPITAL
Provider Other Organization Name Type Code:
3
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:
1568459204
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/27/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 SUNRISE HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AMITYVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11701-2508
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-264-4000
Provider Business Mailing Address Fax Number:
631-396-0025

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 SUNRISE HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AMITYVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11701-2508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-264-4000
Provider Business Practice Location Address Fax Number:
631-396-0025
Provider Enumeration Date:
09/27/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CUSACK
Authorized Official First Name:
MICHELE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
SENIOR VICE PRESIDENT & CFO
Authorized Official Telephone Number:
516-321-6058

Provider Taxonomy Codes

  • Taxonomy code: 283Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00274391 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".