Neurolink Diagnostic and Management, LLC

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

Legal business name

NEUROLINK DIAGNOSTIC AND MANAGEMENT, LLC

Practice address

30 S Ocean Ave RM 103
Freeport, NY 11520-3550

Phone

(631) 602-7073

NPI assigned

Dec 21, 2020

Organization subpart

No

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

Authorized official

Name

Nestor Nicolaides

Title

Provider

Phone

(631) 602-7073

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1608508800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608508800000",
    "number": "1821684143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 33",
            "city": "GLEN HEAD",
            "state": "NY",
            "postal_code": "115450033",
            "telephone_number": "631-602-7073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 S OCEAN AVE RM 103",
            "city": "FREEPORT",
            "state": "NY",
            "postal_code": "115203550",
            "telephone_number": "631-602-7073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEUROLINK DIAGNOSTIC AND MANAGEMENT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-21",
        "last_updated": "2020-12-21",
        "certification_date": "2020-12-21",
        "status": "A",
        "authorized_official_last_name": "NICOLAIDES",
        "authorized_official_first_name": "NESTOR",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "631-602-7073"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Medical Specialty Clinic/Center in Freeport, NY
• Providers in Freeport, NY by specialty
• Medical Specialty Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 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.