Provider Demographics
NPI:1215026471
Name:LONG ISLAND SPINE REHABILITATION MEDICINE, PC
Entity Type:Organization
Organization Name:LONG ISLAND SPINE REHABILITATION MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:S
Authorized Official - Last Name:LIPETZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-393-8941
Mailing Address - Street 1:801 MERRICK AVE
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-4748
Mailing Address - Country:US
Mailing Address - Phone:516-393-8941
Mailing Address - Fax:516-393-8870
Practice Address - Street 1:801 MERRICK AVE
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-4748
Practice Address - Country:US
Practice Address - Phone:516-393-8941
Practice Address - Fax:516-393-8870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty