Provider Demographics
NPI:1942419197
Name:MELILLO CENTER FOR MENTAL HEALTH
Entity Type:Organization
Organization Name:MELILLO CENTER FOR MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:VOGRIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:516-676-2388
Mailing Address - Street 1:113 GLEN COVE AVE
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-3438
Mailing Address - Country:US
Mailing Address - Phone:516-676-2388
Mailing Address - Fax:516-759-5240
Practice Address - Street 1:113 GLEN COVE AVE
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-3438
Practice Address - Country:US
Practice Address - Phone:516-676-2388
Practice Address - Fax:516-759-5240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6804471A251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01321535Medicaid