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General NPI Number Information
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NPI Number | 1669638540
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Entity Type | Organization
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Legal Business Name | MAGDY SHADY NEUROSURGEON PC
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Dates
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Enumeration Date | 07/31/2008
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Last Update Date | 04/09/2009
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Provider Practice Location Address
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Address Line | 2500 NESCONSET HWY BLDG 18C
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City | STONY BROOK
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State | NY
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Zip | 11790-2555
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Country | US
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Telephone | 631-751-2700
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Fax |
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Provider Business Mailing Address
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Address Line | 2500 NESCONSET HWY BLDG 18C
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City | STONY BROOK
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State | NY
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Zip | 11790-2555
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Country | US
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Telephone | 631-751-2700
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Fax |
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | MARILYN RIVERA
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Credential |
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Telephone | 631-751-2700
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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 | 181099
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License Number State | NY
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