Provider Demographics
NPI:1306260096
Name:WEST ISLIP YOUTH ENRICHMENT SERVICES INCORPORATED
Entity type:Organization
Organization Name:WEST ISLIP YOUTH ENRICHMENT SERVICES INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARYANN
Authorized Official - Middle Name:
Authorized Official - Last Name:PFEIFFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-587-5172
Mailing Address - Street 1:PO BOX 105
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-0105
Mailing Address - Country:US
Mailing Address - Phone:631-587-5172
Mailing Address - Fax:631-661-2973
Practice Address - Street 1:401 MAIN ST
Practice Address - Street 2:SUITE #108
Practice Address - City:ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11751-3560
Practice Address - Country:US
Practice Address - Phone:631-446-1950
Practice Address - Fax:631-446-1952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-14
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health