# LONG ISLAND SPINE REHABILITATION MEDICINE, PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215026471
- **Authorized official:** DR. JASON S LIPETZ M.D (PRESIDENT)
- **Authorized official phone:** (516) 393-8941

## Contact information

- **Practice address:** 801 MERRICK AVE, EAST MEADOW, NY 11554-4748
- **Practice address phone:** (516) 393-8941
- **Practice address fax:** (516) 393-8870
- **Mailing address:** 801 MERRICK AVE, EAST MEADOW, NY 11554-4748
- **Mailing address phone:** (516) 393-8941
- **Mailing address fax:** (516) 393-8870

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | NULL | Yes |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/12/2006
- **Last updated:** 08/22/2020