=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740487602
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIFESPAN NEUROLOGICAL PHYSICAL THERAPY, LLP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 303 MERRICK RD SUITE 404
-----------------------------------------------------
City | LYNBROOK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11563-2514
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-255-5511
-----------------------------------------------------
Fax | 516-255-5511
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 303 MERRICK RD SUITE 404
-----------------------------------------------------
City | LYNBROOK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11563-2514
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-255-5511
-----------------------------------------------------
Fax | 516-255-5511
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PARNTER
-----------------------------------------------------
Name | MR. ROBERT PASKOFF
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 516-255-5511
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 006890-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------