Provider Demographics
NPI:1639584543
Name:LONG ISLAND NEUROLOGICAL, PC
Entity Type:Organization
Organization Name:LONG ISLAND NEUROLOGICAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:L
Authorized Official - Last Name:GROSCHEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-926-1115
Mailing Address - Street 1:2805 VETERANS MEMORIAL HWY
Mailing Address - Street 2:SUITE 8
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-7647
Mailing Address - Country:US
Mailing Address - Phone:631-738-8300
Mailing Address - Fax:480-813-1868
Practice Address - Street 1:2805 VETERANS MEMORIAL HWY
Practice Address - Street 2:SUITE 8
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-7647
Practice Address - Country:US
Practice Address - Phone:480-926-1115
Practice Address - Fax:480-813-1868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty