Provider Demographics
NPI:1134253263
Name:TRANSITIONAL SERVICE OF NY FOR LI
Entity type:Organization
Organization Name:TRANSITIONAL SERVICE OF NY FOR LI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUNO
Authorized Official - Middle Name:
Authorized Official - Last Name:LA SPINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-231-3619
Mailing Address - Street 1:840 SUFFOLK AVE
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-4404
Mailing Address - Country:US
Mailing Address - Phone:631-231-3619
Mailing Address - Fax:631-231-4754
Practice Address - Street 1:840 SUFFOLK AVE
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-4404
Practice Address - Country:US
Practice Address - Phone:631-231-3619
Practice Address - Fax:631-231-4754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY01304530320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness