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General NPI Number Information
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NPI Number | 1891136073
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE NEUROLOGY OF LONG ISLAND PC
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Dates
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Enumeration Date | 07/16/2013
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Last Update Date | 02/11/2014
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Provider Practice Location Address
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Address Line | 2500 NESCONSET HWY BLDG 5B
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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 | 347-804-4651
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Fax |
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Provider Business Mailing Address
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Address Line | 3 FAIRWAY DR
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City | OLD BETHPAGE
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State | NY
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Zip | 11804-1706
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Country | US
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Telephone | 516-586-4972
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL GUO
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Credential | M.D.
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Telephone | 347-804-4651
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number | 222499
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License Number State | NY
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