1225314305 NPI number — MS. REGINE PASCALE LILAVOIS DPT

Table of content: MS. REGINE PASCALE LILAVOIS DPT (NPI 1225314305)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225314305 NPI number — MS. REGINE PASCALE LILAVOIS DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LILAVOIS
Provider First Name:
REGINE
Provider Middle Name:
PASCALE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1225314305
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
859 PEPPERIDGE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTBURY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11590
Provider Business Mailing Address Country Code:
UM
Provider Business Mailing Address Telephone Number:
516-425-3152
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1065 OLD COUNTRY RD
Provider Second Line Business Practice Location Address:
SUITE 214
Provider Business Practice Location Address City Name:
WESTBURY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11590-5640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-334-7000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/02/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  032130-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com