Healthcare Provider Details

I. General information

NPI: 1497479794
Provider Name (Legal Business Name): NEUROLOGY MIND CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2022
Last Update Date: 09/29/2022
Certification Date: 09/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1955 MERRICK RD STE 204
MERRICK NY
11566-4635
US

IV. Provider business mailing address

1955 MERRICK RD STE 204
MERRICK NY
11566-4635
US

V. Phone/Fax

Practice location:
  • Phone: 516-636-3873
  • Fax: 516-210-2616
Mailing address:
  • Phone: 516-636-3873
  • Fax: 516-210-2616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARIEL BROOKE DEUTSCH
Title or Position: OWNER
Credential: MD
Phone: 516-636-3873