Organization
SOUTH SHORE NEUROLOGIC ASSOCIATES PC
Active
Other names
Brookhaven MRI
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HENRY GERALD MORETA M.D. (PRESIDENT)
(631) 758-1910
Entity
Organization
Contact information
Practice address
77 MEDFORD AVE, PATCHOGUE, NY 11772-1281
(631) 654-5555
(631) 475-7185
Mailing address
77 MEDFORD AVE, PATCHOGUE, NY 11772
(631) 758-1910
(631) 475-7185
Taxonomy
Speciality
Code
Description
License number
State
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01259347
—
NY
Enumeration date
12/01/2006
Last updated
01/06/2023
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