Provider Demographics
NPI:1083687198
Name:NEW YORK NEUROLOGIC ASSOCIATES, LLP
Entity Type:Organization
Organization Name:NEW YORK NEUROLOGIC ASSOCIATES, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D. - PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SLAVINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-488-1888
Mailing Address - Street 1:3003 NEW HYDE PARK ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1134
Mailing Address - Country:US
Mailing Address - Phone:516-488-1888
Mailing Address - Fax:516-493-3013
Practice Address - Street 1:3003 NEW HYDE PARK ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042
Practice Address - Country:US
Practice Address - Phone:516-488-1888
Practice Address - Fax:516-492-3013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-09
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY121202174400000X
NY216051174400000X
NY156720174400000X
NY212793174400000X
2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH16583Medicare UPIN
NYA64640Medicare UPIN
NYC05175Medicare UPIN
NYH25747Medicare UPIN
NYWU4971Medicare PIN