1548478464 NPI number — MELILLO CENTER FOR MENTAL HEALTH

Table of content: (NPI 1548478464)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548478464 NPI number — MELILLO CENTER FOR MENTAL HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MELILLO CENTER FOR MENTAL HEALTH
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:
1548478464
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
113 GLEN COVE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLEN COVE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11542-3438
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-676-2388
Provider Business Mailing Address Fax Number:
516-759-5259

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
550 GLEN COVE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLEN HEAD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11545-2233
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-676-1863
Provider Business Practice Location Address Fax Number:
516-759-5259
Provider Enumeration Date:
05/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
VOGRIN
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
516-676-2388

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  6804430 , 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)

  • Identifier: 01321535 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com