Provider Demographics
NPI:1295938199
Name:EAST END DISABILITY ASSOCIATES INC.
Entity type:Organization
Organization Name:EAST END DISABILITY ASSOCIATES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:MARTINSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-369-7345
Mailing Address - Street 1:107 ROANOKE AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2700
Mailing Address - Country:US
Mailing Address - Phone:631-369-7345
Mailing Address - Fax:631-369-7346
Practice Address - Street 1:107 ROANOKE AVE
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2700
Practice Address - Country:US
Practice Address - Phone:631-369-7345
Practice Address - Fax:631-369-7346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02252853Medicaid
NY02259709Medicaid
NY01998269Medicaid
NY02663963Medicaid
NY02698406Medicaid
NY02594127Medicaid
NY01933095Medicaid