Provider Demographics
NPI:1467438622
Name:LONG ISLAND NEUROLOGY CONSULTANTS
Entity Type:Organization
Organization Name:LONG ISLAND NEUROLOGY CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOCCI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-887-3516
Mailing Address - Street 1:360 MERRICK RD FL 1
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-2526
Mailing Address - Country:US
Mailing Address - Phone:516-887-3516
Mailing Address - Fax:516-887-0331
Practice Address - Street 1:777 SUNRISE HWY
Practice Address - Street 2:SUITE 200
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563
Practice Address - Country:US
Practice Address - Phone:516-887-3516
Practice Address - Fax:516-887-0331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-20
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY120379,152638,1592362084N0400X, 2084N0400X
NY1475272085R0202X
363AM0700X
NYF303370363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02597928Medicaid
NYCB1510OtherRAILROAD MEDICARE
NY02597928Medicaid
NY=========OtherALL COMM AND HMO INS. CO.
NY=========OtherALL COMM AND HMO INS. CO.
NYW07131Medicare ID - Type UnspecifiedLYNBROOK LOCATION