Provider Demographics
NPI:1952476129
Name:THE YOUNG MEN'S CHRISTIAN ASSOCIATION OF LONG ISLAND INCORPORATED
Entity Type:Organization
Organization Name:THE YOUNG MEN'S CHRISTIAN ASSOCIATION OF LONG ISLAND INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:KATZENBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-674-8290
Mailing Address - Street 1:1150 PORTION RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:HOLTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11742-1074
Mailing Address - Country:US
Mailing Address - Phone:631-580-7777
Mailing Address - Fax:631-580-7773
Practice Address - Street 1:1150 PORTION RD
Practice Address - Street 2:SUITE 6
Practice Address - City:HOLTSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11742-1074
Practice Address - Country:US
Practice Address - Phone:631-580-7777
Practice Address - Fax:631-580-7773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X
NY70611543261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty