Provider Demographics
NPI:1497962583
Name:TOWN OF ISLIP
Entity Type:Organization
Organization Name:TOWN OF ISLIP
Other - Org Name:DEPT OF HUMAN DEVELOPMENT - TASA
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HANK
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-224-5325
Mailing Address - Street 1:401 MAIN ST
Mailing Address - Street 2:ROOM #106
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751-3560
Mailing Address - Country:US
Mailing Address - Phone:631-224-5325
Mailing Address - Fax:631-224-5316
Practice Address - Street 1:401 MAIN ST
Practice Address - Street 2:ROOM #106
Practice Address - City:ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11751-3560
Practice Address - Country:US
Practice Address - Phone:631-224-5325
Practice Address - Fax:631-224-5316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01078748Medicaid