Provider Demographics
NPI:1073813770
Name:ISLAND NEUROLOGY PC
Entity Type:Organization
Organization Name:ISLAND NEUROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DEPT
Authorized Official - Prefix:MISS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRUBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-738-8300
Mailing Address - Street 1:2805 VETERANS MEMORIAL HWY
Mailing Address - Street 2:SUITE 9
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-7647
Mailing Address - Country:US
Mailing Address - Phone:631-738-8300
Mailing Address - Fax:631-738-8500
Practice Address - Street 1:2805 VETERANS MEMORIAL HWY
Practice Address - Street 2:SUITE 9
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-7647
Practice Address - Country:US
Practice Address - Phone:631-738-8300
Practice Address - Fax:631-738-8500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-27
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY181810174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty