| Lish, Inc. | |
|
120 Plant Ave Hauppauge NY 11788-3805 | |
| (631) 650-2510 | |
| (631) 650-0497 |
| Full Name | Lish, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 120 Plant Ave, Hauppauge, New York |
| Authorized Official Name and Position | James Powell (CEO) |
| Authorized Official Contact | 6316502085 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lish, Inc. 159 Carleton Ave Central Islip NY 11722-4172 Ph: (631) 650-2510 | Lish, Inc. 120 Plant Ave Hauppauge NY 11788-3805 Ph: (631) 650-2510 |
| NPI Number | 1700331691 |
|---|---|
| Provider Enumeration Date | 08/20/2016 |
| Last Update Date | 09/27/2019 |
| Medicare PECOS PAC ID | 5991086225 |
|---|---|
| Medicare Enrollment ID | O20170210000302 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700331691 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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