Provider Demographics
NPI:1043577828
Name:LIGHT 101, INC.
Entity Type:Organization
Organization Name:LIGHT 101, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:MARGULIS
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:718-676-9181
Mailing Address - Street 1:2528 E 17TH ST
Mailing Address - Street 2:APT 3C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3516
Mailing Address - Country:US
Mailing Address - Phone:718-676-9181
Mailing Address - Fax:718-676-9180
Practice Address - Street 1:1954 78TH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-1212
Practice Address - Country:US
Practice Address - Phone:718-676-9181
Practice Address - Fax:718-676-9180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1974L001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health