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General NPI Number Information
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NPI Number | 1396948147
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Entity Type | Organization
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Legal Business Name | MASSAPEQUA NEUROLOGIC,PC
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Dates
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Enumeration Date | 06/08/2007
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Last Update Date | 08/27/2020
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Provider Practice Location Address
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Address Line | 95 GRAND AVE
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City | MASSAPEQUA
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State | NY
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Zip | 11758-4905
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Country | US
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Telephone | 516-799-7500
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Fax | 516-799-2075
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Provider Business Mailing Address
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Address Line | 95 GRAND AVE
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City | MASSAPEQUA
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State | NY
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Zip | 11758-4905
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Country | US
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Telephone | 516-799-7500
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Fax | 516-799-2075
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TERESA A FARRUGIA
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Credential | DO
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Telephone | 516-799-7500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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