Provider Demographics
NPI:1679718670
Name:NEURO BRAIN & SPINE SURGERY, P.C.
Entity type:Organization
Organization Name:NEURO BRAIN & SPINE SURGERY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MAGDY
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHADY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-751-2700
Mailing Address - Street 1:2500 NESCONSET HWY
Mailing Address - Street 2:BLDG. 18, SUITE 69
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-2555
Mailing Address - Country:US
Mailing Address - Phone:631-751-2700
Mailing Address - Fax:631-751-5853
Practice Address - Street 1:2500 NESCONSET HWY
Practice Address - Street 2:BLDG. 18, SUITE 69
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-2555
Practice Address - Country:US
Practice Address - Phone:631-751-2700
Practice Address - Fax:631-751-5853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-05
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty