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General NPI Number Information
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NPI Number | 1992901722
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Entity Type | Organization
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Legal Business Name | LONG ISLAND ADOLESCENT & FAMILY SERVICE,INC
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Dates
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Enumeration Date | 06/27/2007
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Last Update Date | 11/18/2014
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Provider Practice Location Address
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Address Line | 1413 STONY BROOK RD
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City | STONY BROOK
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State | NY
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Zip | 11790-2214
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Country | US
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Telephone | 631-444-4400
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Fax |
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Provider Business Mailing Address
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Address Line | 1413 STONY BROOK RD
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City | STONY BROOK
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State | NY
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Zip | 11790-2214
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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 | EXECUTIVE DIRECTOR
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Name | DR. DIANE AQUINO
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Credential |
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Telephone | 631-444-4400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | CH00A09236
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | RH00A09372
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | PJ00A09705
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | SBH00A09585
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License Number State | NY
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