Provider Demographics
NPI:1265529424
Name:NEUROLOGICAL SURGERY PRACTICE OF LONG ISLAND PLLC
Entity type:Organization
Organization Name:NEUROLOGICAL SURGERY PRACTICE OF LONG ISLAND PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:ZORINA
Authorized Official - Middle Name:R
Authorized Official - Last Name:THOMAS-JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:CPC, CPC-I
Authorized Official - Phone:516-442-3461
Mailing Address - Street 1:100 MERRICK RD
Mailing Address - Street 2:SUITE 128 W
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-4800
Mailing Address - Country:US
Mailing Address - Phone:516-442-3461
Mailing Address - Fax:516-442-3462
Practice Address - Street 1:100 MERRICK RD
Practice Address - Street 2:SUITE 128 W
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-4800
Practice Address - Country:US
Practice Address - Phone:516-255-9031
Practice Address - Fax:516-255-6230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW01161Medicare ID - Type Unspecified