Organization
FAMILY SERVICE LEAGUE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRISTIE GOLSON (DIRECTOR OF REVENUE CYCLE MANAGEMEN)
(631) 647-3100
Entity
Organization
Contact information
Practice address
1444 FIFTH AVE, BAY SHORE, NY 11706
(631) 647-3100
(631) 647-2058
Mailing address
1444 5TH AVE, BAY SHORE, NY 11706-4147
(631) 647-3100
(631) 647-2058
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
099472
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
111631827
—
NY
Enumeration date
04/03/2018
Last updated
04/03/2018
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