Provider Demographics
NPI:1366743973
Name:HANDS ACROSS LONG ISLAND, INCORPORATED
Entity type:Organization
Organization Name:HANDS ACROSS LONG ISLAND, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:P
Authorized Official - Last Name:DUBOIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-234-1925
Mailing Address - Street 1:159 BRIGHTSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:CENTRAL ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11722-2710
Mailing Address - Country:US
Mailing Address - Phone:631-234-1925
Mailing Address - Fax:631-234-7258
Practice Address - Street 1:16318 JAMAICA AVE
Practice Address - Street 2:SUITE 601
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-4919
Practice Address - Country:US
Practice Address - Phone:718-206-0888
Practice Address - Fax:718-262-0426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-12
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02871850Medicaid
NYWYRRT1Medicare PIN