1366743973 NPI number — HANDS ACROSS LONG ISLAND, INCORPORATED

Table of content: (NPI 1366743973)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366743973 NPI number — HANDS ACROSS LONG ISLAND, INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HANDS ACROSS LONG ISLAND, INCORPORATED
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:
1366743973
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/24/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
159 BRIGHTSIDE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CENTRAL ISLIP
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11722-2710
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-234-1925
Provider Business Mailing Address Fax Number:
631-234-7258

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16318 JAMAICA AVE
Provider Second Line Business Practice Location Address:
SUITE 601
Provider Business Practice Location Address City Name:
JAMAICA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11432-4919
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-206-0888
Provider Business Practice Location Address Fax Number:
718-262-0426
Provider Enumeration Date:
11/12/2010

Additional Information

Authorized Official

Authorized Official Last Name:
DUBOIS
Authorized Official First Name:
JUDITH
Authorized Official Middle Name:
P
Authorized Official Title or Position:
DEPUTY DIRECTOR
Authorized Official Telephone Number:
631-234-1925

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 02871850 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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