Provider Demographics
NPI:1548369143
Name:TOWN OF ISLIP
Entity type:Organization
Organization Name:TOWN OF ISLIP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DELORES
Authorized Official - Middle Name:
Authorized Official - Last Name:BOCKLET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-224-5330
Mailing Address - Street 1:401 MAIN ST
Mailing Address - Street 2:ROOM 132
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751-3560
Mailing Address - Country:US
Mailing Address - Phone:631-224-5330
Mailing Address - Fax:631-224-1206
Practice Address - Street 1:401 MAIN ST
Practice Address - Street 2:
Practice Address - City:ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11751-3560
Practice Address - Country:US
Practice Address - Phone:631-224-5330
Practice Address - Fax:631-224-1206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY080611082101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01316081Medicaid
NY01316081Medicaid
NYWBW191Medicare ID - Type Unspecified