Provider Demographics
NPI:1073803268
Name:MILITARY COMMUNITY RESOURCE CENTER
Entity Type:Organization
Organization Name:MILITARY COMMUNITY RESOURCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:GINGOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:631-831-2271
Mailing Address - Street 1:38 OAK ST
Mailing Address - Street 2:SUITE #1
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-2883
Mailing Address - Country:US
Mailing Address - Phone:631-569-5811
Mailing Address - Fax:
Practice Address - Street 1:38 OAK ST
Practice Address - Street 2:SUITE #1
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-2883
Practice Address - Country:US
Practice Address - Phone:631-569-5811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-09
Last Update Date:2011-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health