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General NPI Number Information
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NPI Number | 1649738261
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Entity Type | Organization
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Legal Business Name | INNOVATIVE LIFESTYLE SOLUTIONS
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Dates
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Enumeration Date | 03/04/2019
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Last Update Date | 03/04/2019
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Provider Practice Location Address
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Address Line | 2013 CHESTNUT ST
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City | NORTH BALDWIN
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State | NY
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Zip | 11510-2539
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Country | US
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Telephone | 516-209-7347
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Fax |
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Provider Business Mailing Address
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Address Line | 2260 GRAND AVE UNIT 191
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City | BALDWIN
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State | NY
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Zip | 11510-6008
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. FLORENCE E CALLENDER
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Credential | SLP/CCC
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Telephone | 516-209-7347
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number |
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License Number State |
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