Provider Demographics
NPI:1093863565
Name:FAMILY RESIDENCES & ESSENTIAL ENTERPRISES, INC.
Entity Type:Organization
Organization Name:FAMILY RESIDENCES & ESSENTIAL ENTERPRISES, INC.
Other - Org Name:FAMILY WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:BUDD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-273-1300
Mailing Address - Street 1:120 PLANT AVE
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-3805
Mailing Address - Country:US
Mailing Address - Phone:631-273-1300
Mailing Address - Fax:631-273-4342
Practice Address - Street 1:120 PLANT AVE
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-3805
Practice Address - Country:US
Practice Address - Phone:631-273-1300
Practice Address - Fax:631-273-4342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5157205R261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02167980Medicaid
NYW86471Medicare ID - Type UnspecifiedMEDICARE NUMBER