=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295643138
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LONG ISLAND INTEGRATIVE FUNCTIONAL MEDICINE, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2026
-----------------------------------------------------
Last Update Date | 08/31/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 TERRY RD
-----------------------------------------------------
City | SMITHTOWN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11787-3811
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-979-7400
-----------------------------------------------------
Fax | 631-979-7440
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 TERRY RD
-----------------------------------------------------
City | SMITHTOWN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11787-3811
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-979-7400
-----------------------------------------------------
Fax | 631-979-7440
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. EVANGELIA LILA AUGOUSTINIATOS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 631-398-3206
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 202D00000X
-----------------------------------------------------
Taxonomy Name | Integrative Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------