Provider Demographics
NPI:1780822791
Name:LONG ISLAND INFANT DEVELOPMENTAL PROGRAM, INC.
Entity Type:Organization
Organization Name:LONG ISLAND INFANT DEVELOPMENTAL PROGRAM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LENORE
Authorized Official - Middle Name:K
Authorized Official - Last Name:STAMM
Authorized Official - Suffix:
Authorized Official - Credentials:SLPSDA
Authorized Official - Phone:516-546-2333
Mailing Address - Street 1:2174 HEWLETT AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-3606
Mailing Address - Country:US
Mailing Address - Phone:516-546-2333
Mailing Address - Fax:516-546-0038
Practice Address - Street 1:2174 HEWLETT AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-3606
Practice Address - Country:US
Practice Address - Phone:516-546-2333
Practice Address - Fax:516-546-0038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-29
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency