Provider Demographics
NPI:1821015918
Name:LIFELONG THERAPEUTICS
Entity Type:Organization
Organization Name:LIFELONG THERAPEUTICS
Other - Org Name:JEFFREY CIOLINO
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER MGR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:W
Authorized Official - Last Name:CIOLINO
Authorized Official - Suffix:
Authorized Official - Credentials:OTRL
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
Mailing Address - Country:US
Mailing Address - Phone:631-278-0665
Mailing Address - Fax:631-549-1957
Practice Address - Street 1:580 W MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704
Practice Address - Country:US
Practice Address - Phone:631-278-0665
Practice Address - Fax:631-549-1957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ0W6X1Medicare ID - Type Unspecified