South Shore Neurologic Associates PC

Primary specialty

Magnetic Resonance Imaging (MRI) Clinic/CenterTaxonomy code 261QM1200X

Legal business name

SOUTH SHORE NEUROLOGIC ASSOCIATES PC

Doing business as

Brookhaven MRI

Practice address

77 Medford Ave
Patchogue, NY 11772-1281

Phone

(631) 654-5555

Fax

(631) 475-7185

NPI assigned

Dec 1, 2006

Last updated

Jan 6, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Henry Gerald Moreta, M.D.

Title

President

Phone

(631) 758-1910

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Brookhaven MRI Doing business as

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• South Shore Neurologic Associates, PC

  • Durable Medical Equipment & Medical Supplies
  • Patchogue, NY
  • NPI 1700183373
  NPPES parent name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672963200000",
    "number": "1083782460",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "77 MEDFORD AVE",
            "city": "PATCHOGUE",
            "state": "NY",
            "postal_code": "11772",
            "telephone_number": "631-758-1910",
            "fax_number": "631-475-7185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77 MEDFORD AVE",
            "city": "PATCHOGUE",
            "state": "NY",
            "postal_code": "117721281",
            "telephone_number": "631-654-5555",
            "fax_number": "631-475-7185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH SHORE NEUROLOGIC ASSOCIATES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-01",
        "last_updated": "2023-01-06",
        "certification_date": "2023-01-06",
        "status": "A",
        "authorized_official_last_name": "MORETA",
        "authorized_official_first_name": "HENRY",
        "authorized_official_middle_name": "GERALD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "631-758-1910",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Magnetic Resonance Imaging (MRI)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01259347",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brookhaven MRI",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Brookhaven MRI",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Donna Soucy
• Sound Physicians of New York, PLLC
• South Brookhaven Obstetric & Gynecologic Associates PC
• South Country Opticians Inc
• South Shore Medical Solutions LLC
• South Shore Neurologic Associates, PC
• South Shore Speech Pathology
• Joseph P Souza
• Jennifer Nicole Spadavecchia, PHARM.D.
• Deanna Rose Sparaco, RN FNP

• Magnetic Resonance Imaging (MRI) Clinic/Center in Patchogue, NY
• Providers in Patchogue, NY by specialty
• Magnetic Resonance Imaging (MRI) Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.