| Organization Name: | SECOND HOME OF LONG ISLAND LLC |
| NPI Number: | 1073936258 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SERGE DYMERETS (ADMINISTRATOR) |
| Mailing Address: | 336 Fulton Ave Hempstead |
| State: | NY US |
| Postal Code: | 115503907 |
| Phone Number: | 5165900022 |
| Fax Number: | |
| NPI Enumeration Date: | 01/24/2014 |
| NPI Last Update Date: | 01/24/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QA0600X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Adult Day Care |
| Taxonomy Definition: | |