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General NPI Number Information
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NPI Number | 1508508730
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Entity Type | Organization
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Legal Business Name | BRAIN CARE LONG ISLAND PLLC
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Dates
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Enumeration Date | 04/08/2022
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Last Update Date | 10/06/2023
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Provider Practice Location Address
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Address Line | 1175 MONTAUK HIGHWAY SUITE 6
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City | WEST ISLIP
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State | NY
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Zip | 11795-4939
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Country | US
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Telephone | 833-774-6333
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Fax | 631-337-7698
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Provider Business Mailing Address
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Address Line | 1175 MONTAUK HIGHWAY SUITE 6
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City | WEST ISLIP
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State | NY
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Zip | 11795-4939
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Country | US
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Telephone | 833-666-6066
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Fax | 631-337-7698
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Authorized Official
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Title or Position | OWNER
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Name | KEVIN MULLINS
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Credential | M.D.
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Telephone | 833-774-6333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number |
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License Number State |
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