Provider Demographics
NPI:1033478508
Name:PRIME FOR LIFE
Entity Type:Organization
Organization Name:PRIME FOR LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNETTE
Authorized Official - Middle Name:AREANNA
Authorized Official - Last Name:SEEJATTAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-626-1180
Mailing Address - Street 1:1111 BROADHOLLOW RD
Mailing Address - Street 2:STE 214
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-4820
Mailing Address - Country:US
Mailing Address - Phone:631-626-1180
Mailing Address - Fax:631-393-6485
Practice Address - Street 1:1111 BROADHOLLOW RD
Practice Address - Street 2:STE 214
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-4820
Practice Address - Country:US
Practice Address - Phone:631-626-1180
Practice Address - Fax:631-393-6485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-03
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty