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SOUTH SHORE NEUROLOGIC ASSOCIATES P.C.
NPI 1417905969
Psychiatry & Neurology - Neurology in Islip, NY

Active since May 05, 2006
712 MAIN ST, ISLIP, NY 11751(631) 666-3939(631) 666-3994 Get Directions Write a Review

NPPES record last updated: November 8, 2013. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About South Shore Neurologic Associates P.c. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTH SHORE NEUROLOGIC ASSOCIATES P.C. (NPI 1417905969) is a healthcare organization registered as a neurology in Islip, New York and active in the NPI registry since May 2006. The organization lists Angela Deritis, Certified Medical Manager, as its authorized official.

NPPES Registry Identity

NPI1417905969
Entity TypeOrganization
Primary Taxonomy2084N0400X
Legal Business NameSOUTH SHORE NEUROLOGIC ASSOCIATES P.C.
Location Address712 MAIN STIslip, NY 11751-3620
Mailing Address712 Main StIslip, NY 11751-3620 · (631) 666-3939 · Fax (631) 666-3994
Phone(631) 666-3939
Fax(631) 666-3994
Organization SubpartNo
Authorized OfficialAngela DeritisCertified Medical Manager · (631) 666-3939
Enumeration DateMay 5, 2006
Last NPPES UpdateNovember 8, 2013
✔ NPI 1417905969 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychiatry & Neurology · NeurologyAllopathic & Osteopathic Physicians
Taxonomy Code2084N0400X
Definition
A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures.
712 MAIN ST, Islip, NY 11751
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Other Identifiers 3

Medicaid01259347NY
Medicare PINW21181NY
Medicare NSC1313140002NY

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 19

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. MYASSAR ZARIF MD
Psychiatry & Neurology (Neurology)
712 MAIN ST
ISLIP, NY 11751
Suffolk County (631) 666-3939
MRS. SELINA A WILLIAMS RN, FNP
Clinical Nurse Specialist (Family Health)
712 MAIN ST
ISLIP, NY 11751
Suffolk County (631) 666-3939
DR. EDWARD FIROUZTALE DO
Psychiatry & Neurology (Neurology)
712 MAIN ST
ISLIP, NY 11751
Suffolk County (631) 666-3939
DANIELLE WALTHERS NP
Nurse Practitioner (Family)
712 MAIN ST
ISLIP, NY 11751
Suffolk County (631) 666-3939
ELISSA H KRAVIS ANP
Nurse Practitioner (Adult Health)
712 MAIN ST
ISLIP, NY 11751
Suffolk County (631) 666-3951
ELIZABETH KATE HOGAN ANP
Nurse Practitioner (Adult Health)
712 MAIN ST
ISLIP, NY 11751
Suffolk County (631) 666-3939
DR. MARK GUDESBLATT M.D.
Psychiatry & Neurology (Neurology)
712 MAIN ST
ISLIP, NY 11751
Suffolk County (631) 666-3939
DR. NORMAN PFLASTER MD
Psychiatry & Neurology (Neurology)
712 MAIN ST
ISLIP, NY 11751
Suffolk County (631) 666-3939

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is South Shore Neurologic Associates P.C.'s NPI number?

The NPI number for South Shore Neurologic Associates P.C. is 1417905969. It was assigned to this organization in the NPPES registry on May 5, 2006.

Where is South Shore Neurologic Associates P.C. located?

South Shore Neurologic Associates P.C. is located at 712 Main St, Islip, NY 11751. The listed phone number is (631) 666-3939.

What is South Shore Neurologic Associates P.C.'s specialty?

The primary specialty registered for this NPI is Psychiatry & Neurology, specializing in Neurology, with taxonomy code 2084N0400X.

When was this NPI record last updated?

The NPPES record for South Shore Neurologic Associates P.C. was last updated on November 8, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.