Modern Neurology, P.C.
Specialist in Great Neck, NY. Organization (NPI-2).
NPI number1720200322
StatusActive
Last updated in NPPESAug 22, 2020
Details
- NPI
- 1720200322
- Entity type
- Organization (NPI-2)
- Legal business name
- Modern Neurology, P.C.
- Organization subpart
- No
- Enumeration date
- May 3, 2007
- Last updated
- Aug 22, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 174400000X | Specialist | 220993-1 | NY | Yes |
Practice location
1010 Northern BoulevardSuite 208
Great Neck, NY 11021
Phone 516-365-7104 · Fax 718-366-0011
Mailing address
1010 Northern BoulevardSuite 208
Great Neck, NY 11021
Phone 516-365-7104 · Fax 718-366-0011
Authorized official
Samir Haddad
Principal
5163657104
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