# LIFELONG THERAPUTICS INC

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

## Provider details

- **NPI number:** 1649455809
- **Authorized official:** MR. JEFFREY CIOLINO OTR/L (OWNER)
- **Authorized official phone:** (631) 385-2411

## Contact information

- **Practice address:** 337 DEER PARK RD, DIX HILLS, NY 11746-5203
- **Practice address phone:** (631) 385-2411
- **Practice address fax:** (631) 385-2411
- **Mailing address:** 143 CHARDONNAY DR, EAST QUOGUE, NY 11942-3829
- **Mailing address phone:** (631) 385-2411
- **Mailing address fax:** (631) 385-2411

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320700000X | Physical Disabilities Residential Treatment Facility | 2595 | NY | Yes |

## Other

- **Enumeration date:** 01/07/2008
- **Last updated:** 01/07/2008