Provider Demographics
NPI:1043340474
Name:THE DENNELISSE CORPORATION
Entity type:Organization
Organization Name:THE DENNELISSE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SOCIAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:JAQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-265-8320
Mailing Address - Street 1:250 WEST 57TH STREET, SUITE 926
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10107-0926
Mailing Address - Country:US
Mailing Address - Phone:212-265-8320
Mailing Address - Fax:212-246-2547
Practice Address - Street 1:250 WEST 57TH STREET, SUITE 926
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10107-0926
Practice Address - Country:US
Practice Address - Phone:212-265-8320
Practice Address - Fax:212-246-2547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01449994Medicaid