Provider Demographics
NPI:1396948147
Name:MASSAPEQUA NEUROLOGIC,PC
Entity type:Organization
Organization Name:MASSAPEQUA NEUROLOGIC,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:A
Authorized Official - Last Name:FARRUGIA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:516-799-7500
Mailing Address - Street 1:95 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-4905
Mailing Address - Country:US
Mailing Address - Phone:516-799-7500
Mailing Address - Fax:516-799-2075
Practice Address - Street 1:95 GRAND AVE
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-4905
Practice Address - Country:US
Practice Address - Phone:516-799-7500
Practice Address - Fax:516-799-2075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH99877Medicare UPIN
NYMA0WWT4010Medicare PIN
NYWWT401Medicare PIN
NY527N5WT401Medicare PIN