Healthcare Provider Details

I. General information

NPI: 1467438622
Provider Name (Legal Business Name): LONG ISLAND NEUROLOGY CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 MERRICK RD FL 1
LYNBROOK NY
11563-2526
US

IV. Provider business mailing address

360 MERRICK RD FL 1
LYNBROOK NY
11563-2526
US

V. Phone/Fax

Practice location:
  • Phone: 516-887-3516
  • Fax: 516-887-0331
Mailing address:
  • Phone: 516-887-3516
  • Fax: 516-887-0331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number120379,152638,159236
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number147527
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MRS. DONNA BOCCI
Title or Position: OFFICE MANAGER
Credential:
Phone: 516-887-3516