Provider Demographics
NPI:1700939030
Name:MILL NECK FOUNDATION, INC
Entity Type:Organization
Organization Name:MILL NECK FOUNDATION, INC
Other - Org Name:MILL NECK AUDIOLOGY
Other - Org Type:Other Name
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHARON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-628-4212
Mailing Address - Street 1:PO BOX 100
Mailing Address - Street 2:
Mailing Address - City:MILL NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11765-0100
Mailing Address - Country:US
Mailing Address - Phone:516-628-4200
Mailing Address - Fax:516-922-1773
Practice Address - Street 1:40 FROST MILL RD
Practice Address - Street 2:
Practice Address - City:MILL NECK
Practice Address - State:NY
Practice Address - Zip Code:11765-1102
Practice Address - Country:US
Practice Address - Phone:516-628-4200
Practice Address - Fax:516-922-1773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01479450Medicaid