Healthcare Provider Details

I. General information

NPI: 1871474411
Provider Name (Legal Business Name): LILA HOLISTICS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2025
Last Update Date: 09/10/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2228 MONTAUK HWY
BRIDGEHAMPTON NY
11932-4001
US

IV. Provider business mailing address

418 BROADWAY # 8839
ALBANY NY
12207-2922
US

V. Phone/Fax

Practice location:
  • Phone: 631-500-5452
  • Fax:
Mailing address:
  • Phone: 631-500-5452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. DORI FORTUNATO
Title or Position: OWNER
Credential: DAOM LIC. AC LMT
Phone: 631-500-5452