Provider Demographics
NPI:1033480447
Name:ADVANCED NEUROLOGICAL SERVICES OF LONG ISLAND PC
Entity Type:Organization
Organization Name:ADVANCED NEUROLOGICAL SERVICES OF LONG ISLAND PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:F
Authorized Official - Last Name:KLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-541-0300
Mailing Address - Street 1:880 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-2351
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:880 N BROADWAY
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-2351
Practice Address - Country:US
Practice Address - Phone:516-541-0300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-17
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty