Healthcare Provider Details

I. General information

NPI: 1891136073
Provider Name (Legal Business Name): COMPREHENSIVE NEUROLOGY OF LONG ISLAND PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2013
Last Update Date: 02/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NESCONSET HWY BLDG 5B
STONY BROOK NY
11790-2555
US

IV. Provider business mailing address

3 FAIRWAY DR
OLD BETHPAGE NY
11804-1706
US

V. Phone/Fax

Practice location:
  • Phone: 347-804-4651
  • Fax:
Mailing address:
  • Phone: 516-586-4972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number222499
License Number StateNY

VIII. Authorized Official

Name: DR. MICHAEL GUO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 347-804-4651