Provider Demographics
NPI:1629225867
Name:NESCONSET ACQUISITION LLC
Entity Type:Organization
Organization Name:NESCONSET ACQUISITION LLC
Other - Org Name:ISLIP ADHS
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:HEPPENHEIMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-361-8800
Mailing Address - Street 1:100 SOUTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:NESCONSET
Mailing Address - State:NY
Mailing Address - Zip Code:11767-1749
Mailing Address - Country:US
Mailing Address - Phone:631-361-8800
Mailing Address - Fax:631-361-9528
Practice Address - Street 1:575 CLAYTON ST
Practice Address - Street 2:
Practice Address - City:CENTRAL ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11722-3021
Practice Address - Country:US
Practice Address - Phone:631-234-0550
Practice Address - Fax:631-234-0635
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NESCONSET ACQUISITION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-19
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5157315N311Z00000X
NY5157507N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00848751Medicaid