Healthcare Provider Details

I. General information

NPI: 1447441431
Provider Name (Legal Business Name): ISLAND NEURODIAGNOSTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 08/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 OLD COUNTRY RD
PLAINVIEW NY
11803-4950
US

IV. Provider business mailing address

824 OLD COUNTRY RD
PLAINVIEW NY
11803-4950
US

V. Phone/Fax

Practice location:
  • Phone: 516-822-2230
  • Fax: 516-822-0163
Mailing address:
  • Phone: 516-822-2230
  • Fax: 516-822-0163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MS. DEBORAH SCOTTO-LAVINO
Title or Position: BUSINESS MANAGER
Credential:
Phone: 516-822-2230