Provider Demographics
NPI:1235250614
Name:EAST END NEUROLOGY PLLC
Entity Type:Organization
Organization Name:EAST END NEUROLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:ALBERTO
Authorized Official - Last Name:REILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-734-7648
Mailing Address - Street 1:1 OAK RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:MANORVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11949-3240
Mailing Address - Country:US
Mailing Address - Phone:631-734-7648
Mailing Address - Fax:631-734-7287
Practice Address - Street 1:15 N OCEAN AVE
Practice Address - Street 2:
Practice Address - City:CENTER MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11934-2320
Practice Address - Country:US
Practice Address - Phone:631-734-7648
Practice Address - Fax:631-734-7287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2084482084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0212002Medicaid
NY81L671Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER ID
NYG95411Medicare UPIN
NYWU4961Medicare ID - Type UnspecifiedGROUP MEDICARE ID