Provider Demographics
NPI:1154754190
Name:DEL TEJO, LISA T (MS SPED B-2)
Entity type:Individual
Prefix:MISS
First Name:LISA
Middle Name:T
Last Name:DEL TEJO
Suffix:
Gender:F
Credentials:MS SPED B-2
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:298 33RD ST
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-3237
Mailing Address - Country:US
Mailing Address - Phone:631-495-3757
Mailing Address - Fax:
Practice Address - Street 1:298 33RD ST
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-3237
Practice Address - Country:US
Practice Address - Phone:631-495-3757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY471683101252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency