Long Island Neuropsychology, P.C.

Primary specialty

Forensic PsychologistTaxonomy code 103TF0200X

License

012998 Issued in NY

Legal business name

LONG ISLAND NEUROPSYCHOLOGY, P.C.

Practice address

290 Hawkins Ave
Suite B
Lake Ronkonkoma, NY 11779-9600

Phone

(631) 334-7884

NPI assigned

Mar 21, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Shane S. Bush, PH.D.NPI 1003868514

Title

President

Phone

(631) 334-7884

Specialties & licenses 5

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Shane Bush, PH.D.

  • Clinical Neuropsychologist
  • Lake Ronkonkoma, NY
  • NPI 1003868514
  NPD (past) Authorized official

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

{
    "created_epoch": "1174435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1356467419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "290 HAWKINS AVE",
            "address_2": "SUITE B",
            "city": "LAKE RONKONKOMA",
            "state": "NY",
            "postal_code": "117799600",
            "telephone_number": "631-334-7884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "290 HAWKINS AVE",
            "address_2": "SUITE B",
            "city": "LAKE RONKONKOMA",
            "state": "NY",
            "postal_code": "117799600",
            "telephone_number": "631-334-7884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONG ISLAND NEUROPSYCHOLOGY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-21",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "BUSH",
        "authorized_official_first_name": "SHANE",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "631-334-7884",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": "NY",
            "license": "012998",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "NY",
            "license": "012998",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "012998",
            "primary": false
        },
        {
            "code": "103TF0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Forensic",
            "state": "NY",
            "license": "012998",
            "primary": true
        },
        {
            "code": "103TR0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Rehabilitation",
            "state": "NY",
            "license": "012998",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Terri Leonard, M.S.
• David Ross Leonoff, DDS
• Julie M. Lewis
• Amanda Little, L.P.N.
• Melissa Lo Faso-Arcangel, REGISTERED NURSE
• Long Island, Queens Hearing Asso Inc
• Sarah N Mangan, M.ED. CF-SLP
• Alisha Hailey Marine
• Eileen Marino Clark, MS
• Kelly Teresa Marvullo

• Forensic Psychologist in Lake Ronkonkoma, NY
• Providers in Lake Ronkonkoma, NY by specialty
• Forensic Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.