1558490656 NPI number — ISLAND NEUROLOGICAL ASSOCIATES, P. C.

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 1558490656 NPI number — ISLAND NEUROLOGICAL ASSOCIATES, P. C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ISLAND NEUROLOGICAL ASSOCIATES, P. C.
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:
1558490656
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1575 HILLSIDE AVE
Provider Second Line Business Mailing Address:
CO MDB INC SUITE LL3
Provider Business Mailing Address City Name:
NEW HYDE PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11040-2501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-354-0071
Provider Business Mailing Address Fax Number:
516-354-0415

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
824 OLD COUNTRY RD
Provider Second Line Business Practice Location Address:
MRI SUITE
Provider Business Practice Location Address City Name:
PLAINVIEW
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11803-4950
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-822-2230
Provider Business Practice Location Address Fax Number:
516-354-0415
Provider Enumeration Date:
03/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
NEWMAN
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
516-822-2230

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  116328 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: 116326 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: 129480 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: 228114 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: 120022 , 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)

  • Identifier: 02759339 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1578549101 . This is a "SM NEWMAN, MD (NPI)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1811973449 . This is a "JOHN KELEMEN, MD (NPI)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1861477820 . This is a "ERIK ENTIN, MD (NPI)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00942549 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00397080 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00397099 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00397104 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1306822929 . This is a "IRA M TURNER, MD (NPI)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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