Provider Demographics
NPI:1063515559
Name:EPILEPSY FOUNDATION OF LONG ISLAND
Entity type:Organization
Organization Name:EPILEPSY FOUNDATION OF LONG ISLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTOLLER
Authorized Official - Prefix:
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:LUBELSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-739-7733
Mailing Address - Street 1:34 HARDING ST
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-5523
Mailing Address - Country:US
Mailing Address - Phone:631-467-2590
Mailing Address - Fax:
Practice Address - Street 1:506 STEWART AVE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-4706
Practice Address - Country:US
Practice Address - Phone:516-739-7733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010370225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW1L021Medicare ID - Type Unspecified