Provider Demographics
NPI:1861143521
Name:THE DENNELISSE CORPORATION
Entity type:Organization
Organization Name:THE DENNELISSE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:ANAELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-265-8320
Mailing Address - Street 1:460 WILLIS AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10455-4013
Mailing Address - Country:US
Mailing Address - Phone:212-265-8320
Mailing Address - Fax:646-878-0355
Practice Address - Street 1:460 WILLIS AVE FL 2
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-4013
Practice Address - Country:US
Practice Address - Phone:212-265-8320
Practice Address - Fax:646-878-0355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-14
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management