Provider Demographics
NPI:1740469154
Name:PROJEACT OUTREACH
Entity type:Organization
Organization Name:PROJEACT OUTREACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-481-2890
Mailing Address - Street 1:600 HEMPSTEAD TPKE
Mailing Address - Street 2:
Mailing Address - City:W HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-1095
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 HEMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:W HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-1095
Practice Address - Country:US
Practice Address - Phone:516-481-2890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:N. SHORE/LIJ HEALTH SYSTEMS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-01
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO50300-1261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center