1265987150 NPI number — LONG ISLAND SELECT HEALTHCARE, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265987150 NPI number — LONG ISLAND SELECT HEALTHCARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LONG ISLAND SELECT HEALTHCARE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LISH, INC.
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265987150
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/14/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
159 CARLETON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CENTRAL ISLIP
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11722-4172
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-650-2510
Provider Business Mailing Address Fax Number:
631-650-0497

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
883 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIVERHEAD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11901-2613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-650-2510
Provider Business Practice Location Address Fax Number:
631-650-0497
Provider Enumeration Date:
08/20/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BRIEGER
Authorized Official First Name:
KATHY
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
631-650-2085

Provider Taxonomy Codes

  • Taxonomy code: 261QD1600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)