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General NPI Number Information
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NPI Number | 1174563936
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Entity Type | Organization
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Legal Business Name | EPIC LONG ISLAND
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Dates
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Enumeration Date | 06/08/2006
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Last Update Date | 09/19/2016
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Provider Practice Location Address
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Address Line | 1500 HEMPSTEAD TPKE
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City | EAST MEADOW
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State | NY
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Zip | 11554-1551
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Country | US
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Telephone | 516-739-7733
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Fax | 516-861-3860
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Provider Business Mailing Address
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Address Line | 1500 HEMPSTEAD TPKE
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City | EAST MEADOW
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State | NY
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Zip | 11554-1551
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Country | US
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Telephone | 516-739-7733
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Fax | 516-861-3860
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Authorized Official
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Title or Position | CFO
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Name | MR. LAWRENCE BOORD
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Credential |
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Telephone | 516-739-7733
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number | 6751100
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number | 675100
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License Number State | NY
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