Provider Demographics
NPI:1306013545
Name:EPILEPSY FOUNDATION OF LONG ISLAND
Entity Type:Organization
Organization Name:EPILEPSY FOUNDATION OF LONG ISLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:LUBELSKY
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:516-739-7733
Mailing Address - Street 1:506 STEWART AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-4706
Mailing Address - Country:US
Mailing Address - Phone:516-739-7733
Mailing Address - Fax:516-739-1859
Practice Address - Street 1:506 STEWART AVE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-4706
Practice Address - Country:US
Practice Address - Phone:516-739-7733
Practice Address - Fax:516-739-1859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00475952320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00475952Medicaid
NY00475952Medicaid