1629013495 NPI number — NEUROLOGICAL ASSOCIATES OF LONG ISLAND, PC

Table of content: (NPI 1629013495)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629013495 NPI number — NEUROLOGICAL ASSOCIATES OF LONG ISLAND, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEUROLOGICAL ASSOCIATES OF LONG ISLAND, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629013495
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/21/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1991 MARCUS AVENUE
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
LAKE SUCCESS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11042-2057
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-466-4700
Provider Business Mailing Address Fax Number:
516-466-4810

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1991 MARCUS AVENUE
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
LAKE SUCCESS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11042-2057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-466-4700
Provider Business Practice Location Address Fax Number:
516-466-4810
Provider Enumeration Date:
06/17/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KORETZ
Authorized Official First Name:
ERIKA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OFFICE ADMINISTRATOR
Authorized Official Telephone Number:
516-466-4700

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 41996 . This is a "AETNA INS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".