Provider Demographics
NPI:1225665573
Name:LIFELONG REHAB INC
Entity Type:Organization
Organization Name:LIFELONG REHAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:CIOLINO
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:631-278-0665
Mailing Address - Street 1:143 CHARDONNAY DR
Mailing Address - Street 2:
Mailing Address - City:EAST QUOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11942-3829
Mailing Address - Country:US
Mailing Address - Phone:631-278-0665
Mailing Address - Fax:
Practice Address - Street 1:143 CHARDONNAY DR
Practice Address - Street 2:
Practice Address - City:EAST QUOGUE
Practice Address - State:NY
Practice Address - Zip Code:11942-3829
Practice Address - Country:US
Practice Address - Phone:631-278-0665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-26
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty