Healthcare Provider Details

I. General information

NPI: 1295218592
Provider Name (Legal Business Name): LIL EINSTEIN INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2018
Last Update Date: 09/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 RIDGEWOOD ST
VALLEY STREAM NY
11580-2508
US

IV. Provider business mailing address

672 DOGWOOD AVE # 211
FRANKLIN SQUARE NY
11010-3247
US

V. Phone/Fax

Practice location:
  • Phone: 917-406-3243
  • Fax:
Mailing address:
  • Phone: 917-406-3243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. MARIBEL LINO
Title or Position: SPECIAL INSTRUCTION
Credential: MSED, TSHH
Phone: 917-406-3243