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General NPI Number Information
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NPI Number | 1952476129
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Entity Type | Organization
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Legal Business Name | THE YOUNG MEN'S CHRISTIAN ASSOCIATION OF LONG ISLAND INCORPORATED
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Dates
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Enumeration Date | 11/22/2006
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Last Update Date | 04/03/2017
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Provider Practice Location Address
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Address Line | 1150 PORTION RD SUITE 6
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City | HOLTSVILLE
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State | NY
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Zip | 11742-1074
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Country | US
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Telephone | 631-580-7777
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Fax | 631-580-7773
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Provider Business Mailing Address
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Address Line | 1150 PORTION RD SUITE 6
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City | HOLTSVILLE
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State | NY
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Zip | 11742-1074
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Country | US
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Telephone | 631-580-7777
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Fax | 631-580-7773
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Authorized Official
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Title or Position | CFO
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Name | MR. MARK KATZENBERGER
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Credential |
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Telephone | 516-674-8290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 70611543
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License Number State | NY
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