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General NPI Number Information
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NPI Number | 1861786840
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Entity Type | Organization
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Legal Business Name | DIAGNOSTIC NEUROLIGICAL TREATMENT CENTER LLC
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Dates
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Enumeration Date | 06/07/2011
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Last Update Date | 06/07/2011
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Provider Practice Location Address
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Address Line | 945 HUGUENOT AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10312-4312
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Country | US
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Telephone | 718-524-0500
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Fax |
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Provider Business Mailing Address
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Address Line | 90 MILLS AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10305-4524
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Country | US
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Telephone | 718-524-0500
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOSEPH MORMINO
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Credential | M.D.
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Telephone | 718-524-0500
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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 | 101545
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License Number State | NY
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