Provider Demographics
NPI:1235533993
Name:WINTHROP FACULTY MEDICAL AFFILIATES UNIVERSITY FACULTY PRACTICE CORP
Entity Type:Organization
Organization Name:WINTHROP FACULTY MEDICAL AFFILIATES UNIVERSITY FACULTY PRACTICE CORP
Other - Org Name:WINTHROP CHILD NEUROLOGY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:AMMAZZALORSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-663-8209
Mailing Address - Street 1:700 HICKSVILLE RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-3471
Mailing Address - Country:US
Mailing Address - Phone:516-576-5715
Mailing Address - Fax:516-576-5801
Practice Address - Street 1:173 MINEOLA BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-2528
Practice Address - Country:US
Practice Address - Phone:516-663-9494
Practice Address - Fax:516-663-2835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-09
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Multi-Specialty