Healthcare Provider Details

I. General information

NPI: 1295643138
Provider Name (Legal Business Name): LONG ISLAND INTEGRATIVE FUNCTIONAL MEDICINE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 TERRY RD
SMITHTOWN NY
11787-3811
US

IV. Provider business mailing address

100 TERRY RD
SMITHTOWN NY
11787-3811
US

V. Phone/Fax

Practice location:
  • Phone: 631-979-7400
  • Fax: 631-979-7440
Mailing address:
  • Phone: 631-979-7400
  • Fax: 631-979-7440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. EVANGELIA LILA AUGOUSTINIATOS
Title or Position: PRESIDENT
Credential: MD
Phone: 631-398-3206