| Long Island Neurological, Pc | |
|
10119 39th Ave Suite # 101 Corona NY 11368-4806 | |
| (347) 808-8324 | |
| (347) 808-8326 |
| Full Name | Long Island Neurological, Pc |
|---|---|
| Speciality | Psychiatry & Neurology - Neurology |
| Location | 10119 39th Ave, Corona, New York |
| Authorized Official Name and Position | Victor Manuel Macias (GENERAL MANAGER) |
| Authorized Official Contact | 7572407848 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Long Island Neurological, Pc 10119 39th Ave Suite # 101 Corona NY 11368-4806 Ph: (347) 808-8324 | Long Island Neurological, Pc 10119 39th Ave Suite # 101 Corona NY 11368-4806 Ph: (347) 808-8324 |
| NPI Number | 1174892798 |
|---|---|
| Provider Enumeration Date | 12/28/2011 |
| Last Update Date | 12/28/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174892798 | NPI | - | NPPES |
| 220993 | Other | NY | LICENSE NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | 220993 (New York) | Primary |
| 225100000X | Physical Therapist | 025085 (New York) | Secondary |
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