Provider Demographics
NPI:1295859403
Name:METROPOLITAN PEDIATRIC NEUROLOGY PC
Entity Type:Organization
Organization Name:METROPOLITAN PEDIATRIC NEUROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELISA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-829-3100
Mailing Address - Street 1:1000 NORTHERN BLVD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5312
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1000 NORTHERN BLVD
Practice Address - Street 2:SUITE 240
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5312
Practice Address - Country:US
Practice Address - Phone:516-829-3100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00845881Medicaid
NY00845881Medicaid