Provider Demographics
NPI:1104979798
Name:MERRICK UFSD
Entity type:Organization
Organization Name:MERRICK UFSD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF STUDENT SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:SALVATORE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOSSENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-992-7295
Mailing Address - Street 1:21 BABYLON RD
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-4549
Mailing Address - Country:US
Mailing Address - Phone:516-992-7293
Mailing Address - Fax:
Practice Address - Street 1:21 BABYLON RD
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-4549
Practice Address - Country:US
Practice Address - Phone:516-992-7293
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01382356Medicaid