| Organization Name: | SOUTH SHORE NEUROLOGIC ASSOC PC |
| NPI Number: | 1083782460 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | HENRY GERALD MORETA (PRESIDENT) |
| Mailing Address: | 77 Medford Ave Patchogue |
| State: | NY US |
| Postal Code: | 117721281 |
| Phone Number: | 6316545555 |
| Fax Number: | 6314757185 |
| NPI Enumeration Date: | 12/01/2006 |
| NPI Last Update Date: | 06/12/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM1200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Magnetic Resonance Imaging (MRI) |
| Taxonomy Definition: | |