Healthcare Provider Details

I. General information

NPI: 1154251932
Provider Name (Legal Business Name): RESOURCES AND INNOVATION FOR SPECTRUM EXCELLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 GARY PL
SELDEN NY
11784-1508
US

IV. Provider business mailing address

3 GARY PL
SELDEN NY
11784-1508
US

V. Phone/Fax

Practice location:
  • Phone: 631-404-6871
  • Fax:
Mailing address:
  • Phone: 631-404-6871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. RAFI FAZLI
Title or Position: PRESIDENT
Credential:
Phone: 631-404-6871