Healthcare Provider Details

I. General information

NPI: 1538848742
Provider Name (Legal Business Name): VIRGIN ISLAND NEUROLOGY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2023
Last Update Date: 07/14/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254-A ESTATE GLENN
KINGSHILL VI
00850-0100
US

IV. Provider business mailing address

61 CAROL ST
LYNBROOK NY
11563-1125
US

V. Phone/Fax

Practice location:
  • Phone: 340-642-5705
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. IRINA GOLDENSTEIN
Title or Position: BILLING MANAGER
Credential:
Phone: 516-887-7605