NPIMap

Organization Active NPI

Modern Neurology, P.C.

  • Specialist
  • Great Neck, NY
National Provider Identifier
1720200322
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
220993-1 Issued in NY
Legal business name
MODERN NEUROLOGY, P.C.
Practice address
1010 Northern Boulevard
Suite 208
Great Neck, NY 11021
Phone
(516) 365-7104
Fax
(718) 366-0011
NPI assigned
May 3, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Samir Haddad, M.D.
Title
Principal
Phone
(516) 365-7104

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 220993-1 NY Primary

Addresses

Primary practice location

1010 Northern Boulevard
Suite 208
Great Neck, NY 11021

Mailing address

1010 Northern Boulevard
Suite 208
Great Neck, NY 11021
Phone (516) 365-7104

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1720200322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 NORTHERN BOULEVARD",
            "address_2": "SUITE 208",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "11021",
            "telephone_number": "516-365-7104",
            "fax_number": "718-366-0011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 NORTHERN BOULEVARD",
            "address_2": "SUITE 208",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "11021",
            "telephone_number": "516-365-7104",
            "fax_number": "718-366-0011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN NEUROLOGY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HADDAD",
        "authorized_official_first_name": "SAMIR",
        "authorized_official_title_or_position": "PRINCIPAL",
        "authorized_official_telephone_number": "516-365-7104",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "NY",
            "license": "220993-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Great Neck, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.