South Shore Neurologic Associates P.C.

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

Legal business name

SOUTH SHORE NEUROLOGIC ASSOCIATES P.C.

Practice address

712 Main St
Islip, NY 11751-3620

Phone

(631) 666-3939

Fax

(631) 666-3994

NPI assigned

May 5, 2006

Organization subpart

No

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

Authorized official

Name

Ms. Angela Deritis, CMM

Title

Certified Medical Manager

Phone

(631) 666-3939

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 2

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

• Lisa Michelle Hodge-Scelsa, NURSE PRACTITIONER

  • Adult Health Nurse Practitioner
  • Patchogue, NY
  • NPI 1104922244
  NPD (past)
• Debra Depto, PT

  • Pediatric Physical Therapist
  • Ponte Vedra, FL
  • NPI 1598710741
  NPD (past)

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

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1383868800000",
    "number": "1417905969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "712 MAIN ST",
            "city": "ISLIP",
            "state": "NY",
            "postal_code": "117513620",
            "telephone_number": "631-666-3939",
            "fax_number": "631-666-3994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "712 MAIN ST",
            "city": "ISLIP",
            "state": "NY",
            "postal_code": "117513620",
            "telephone_number": "631-666-3939",
            "fax_number": "631-666-3994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH SHORE NEUROLOGIC ASSOCIATES P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-05",
        "last_updated": "2013-11-08",
        "status": "A",
        "authorized_official_last_name": "DERITIS",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_title_or_position": "CERTIFIED MEDICAL MANAGER",
        "authorized_official_telephone_number": "631-666-3939",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "CMM"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01259347",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Scott A Snyder, DC
• Feliz Solis, PT
• Bonnie Neidecker Soukup, LMHC, NCC
• South Bay Orthodontics
• South Bay Physical Therapy and Sports Rehabilitation PC (Great South Bay Physical Therapy & Sports Rehabilitation PC)
• Donna Spada, LCSW
• Spectrum Care Companions, LLC
• Kimberly Stango, MA, SLP
• Marvin L Stern, DDS
• Marcelina Migdalia Stewart, RN

• Neurology Physician in Islip, NY
• Providers in Islip, NY by specialty
• Neurology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2013; 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.