Provider Demographics
NPI:1407856933
Name:NEUROLOGICAL SPECIALTIES OF LONG ISLAND, PLLC
Entity Type:Organization
Organization Name:NEUROLOGICAL SPECIALTIES OF LONG ISLAND, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ITZHAK
Authorized Official - Middle Name:
Authorized Official - Last Name:HAIMOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-773-0089
Mailing Address - Street 1:170 GREAT NECK RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-3337
Mailing Address - Country:US
Mailing Address - Phone:516-487-4464
Mailing Address - Fax:516-487-4950
Practice Address - Street 1:170 GREAT NECK RD
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-3337
Practice Address - Country:US
Practice Address - Phone:516-487-4464
Practice Address - Fax:516-487-4950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty