Basic Information
| Provider Information | |||||||||
| NPI: | 1558455089 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FIVE TOWNS NEUROLOGY, PC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | WOODMERE SLEEP CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 923 BROADWAY | ||||||||
| Address2: | |||||||||
| City: | WOODMERE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115981739 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5162391800 | ||||||||
| FaxNumber: | 5162955557 | ||||||||
| Practice Location | |||||||||
| Address1: | 923 BROADWAY | ||||||||
| Address2: | |||||||||
| City: | WOODMERE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115981739 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5162391800 | ||||||||
| FaxNumber: | 5162955557 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | STEINER | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5162391800 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 02593502 | 05 | NY | MEDICAID |