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General NPI Number Information
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NPI Number | 1316335540
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Entity Type | Organization
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Legal Business Name | NORTH SUFFOLK NEUROLOGY, PC
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Dates
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Enumeration Date | 12/22/2014
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Last Update Date | 12/13/2016
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Provider Practice Location Address
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Address Line | 5 MEDICAL DR
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City | PORT JEFFERSON STATION
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State | NY
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Zip | 11776-1601
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Country | US
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Telephone | 631-364-9119
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Fax | 631-364-9118
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Provider Business Mailing Address
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Address Line | 5 MEDICAL DR
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City | PORT JEFFERSON STATION
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State | NY
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Zip | 11776-1601
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Country | US
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Telephone | 631-364-9119
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Fax | 631-364-9118
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER/MED. DIR.
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Name | DR. WARREN DANIEL SPINNER
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Credential | D.O.
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Telephone | 631-942-2516
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 242921
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License Number State | NY
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