Provider Demographics
NPI:1861786840
Name:DIAGNOSTIC NEUROLIGICAL TREATMENT CENTER LLC
Entity type:Organization
Organization Name:DIAGNOSTIC NEUROLIGICAL TREATMENT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:MORMINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-524-0500
Mailing Address - Street 1:90 MILLS AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-4524
Mailing Address - Country:US
Mailing Address - Phone:718-524-0500
Mailing Address - Fax:
Practice Address - Street 1:945 HUGUENOT AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-4312
Practice Address - Country:US
Practice Address - Phone:718-524-0500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101545207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty