1316335540 NPI number — NORTH SUFFOLK NEUROLOGY, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316335540 NPI number — NORTH SUFFOLK NEUROLOGY, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH SUFFOLK NEUROLOGY, 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:
1316335540
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/13/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5 MEDICAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORT JEFFERSON STATION
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11776-1601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-364-9119
Provider Business Mailing Address Fax Number:
631-364-9118

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5 MEDICAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT JEFFERSON STATION
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11776-1601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-364-9119
Provider Business Practice Location Address Fax Number:
631-364-9118
Provider Enumeration Date:
12/22/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SPINNER
Authorized Official First Name:
WARREN
Authorized Official Middle Name:
DANIEL
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER/MED. DIR.
Authorized Official Telephone Number:
631-942-2516

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  242921 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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