Provider Demographics
NPI:1447603501
Name:LONG ISLAND SELECT HEALTHCARE, INC.
Entity Type:Organization
Organization Name:LONG ISLAND SELECT HEALTHCARE, INC.
Other - Org Name:LISH, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-650-2085
Mailing Address - Street 1:159 CARLETON AVE
Mailing Address - Street 2:
Mailing Address - City:CENTRAL ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11722-4172
Mailing Address - Country:US
Mailing Address - Phone:631-650-2510
Mailing Address - Fax:631-650-0497
Practice Address - Street 1:75 LANDING MEADOW RD
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-1124
Practice Address - Country:US
Practice Address - Phone:631-650-2510
Practice Address - Fax:631-650-0497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-13
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center