NPIMap

Organization Active NPI

Long Island Neurological, PC

  • Neurology Physician
  • Corona, NY
National Provider Identifier
1174892798
Registry record updated Dec 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
220993 Issued in NY
Legal business name
LONG ISLAND NEUROLOGICAL, PC
Practice address
10119 39TH Ave
Suite # 101
Corona, NY 11368-4806
Phone
(347) 808-8324
Fax
(347) 808-8326
NPI assigned
Dec 28, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2011

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

Authorized official

Name
Mr. Victor Manuel Macias
Title
General Manager
Phone
(757) 240-7848

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084N0400X 220993 NY Primary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X 025085 NY

Addresses

Primary practice location

10119 39TH Ave
Suite # 101
Corona, NY 11368-4806

Mailing address

10119 39TH Ave
Suite # 101
Corona, NY 11368-4806
Phone (347) 808-8324

Other identifiers 1

IdentifierTypeStateIssuer
220993OtherNYLICENSE NUMBER

National Provider Directory

National Provider Directory
Tax ID family
Long Island Neurological PC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1325030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1325030400000",
    "number": "1174892798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10119 39TH AVE",
            "address_2": "SUITE # 101",
            "city": "CORONA",
            "state": "NY",
            "postal_code": "113684806",
            "telephone_number": "347-808-8324",
            "fax_number": "347-808-8326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10119 39TH AVE",
            "address_2": "SUITE # 101",
            "city": "CORONA",
            "state": "NY",
            "postal_code": "113684806",
            "telephone_number": "347-808-8324",
            "fax_number": "347-808-8326"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONG ISLAND NEUROLOGICAL, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-28",
        "last_updated": "2011-12-28",
        "status": "A",
        "authorized_official_last_name": "MACIAS",
        "authorized_official_first_name": "VICTOR",
        "authorized_official_middle_name": "MANUEL",
        "authorized_official_title_or_position": "GENERAL MANAGER",
        "authorized_official_telephone_number": "757-240-7848",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "NY",
            "license": "220993",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "025085",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "220993",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Corona, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2011; 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.