Provider Demographics
NPI:1972534246
Name:STORMS, NEIL H (PA)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:H
Last Name:STORMS
Suffix:
Gender:M
Credentials:PA
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:6 TECHNOLOGY DR STE 100
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-4079
Mailing Address - Country:US
Mailing Address - Phone:631-689-6698
Mailing Address - Fax:631-751-5548
Practice Address - Street 1:6 TECHNOLOGY DR STE 100
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-4079
Practice Address - Country:US
Practice Address - Phone:631-689-6698
Practice Address - Fax:631-751-5548
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2019-05-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY005124363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S68051Medicare UPIN
NY0F135X0281Medicare PIN