Provider Demographics
NPI:1457232290
Name:SPINE CARE MEDICAL LONG ISLAND LLC
Entity type:Organization
Organization Name:SPINE CARE MEDICAL LONG ISLAND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BERNICE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-827-7672
Mailing Address - Street 1:110 E MAIN ST STE 4
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2845
Mailing Address - Country:US
Mailing Address - Phone:631-802-6469
Mailing Address - Fax:631-824-2755
Practice Address - Street 1:110 E MAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2845
Practice Address - Country:US
Practice Address - Phone:631-802-6469
Practice Address - Fax:631-824-2755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-09
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty