Organization
LONG ISLAND NEUROPSYCHOLOGY, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHANE S. BUSH PH.D. (PRESIDENT)
(631) 334-7884
Entity
Organization
Contact information
Practice address
290 HAWKINS AVE, SUITE B, LAKE RONKONKOMA, NY 11779-9600
(631) 334-7884
Mailing address
290 HAWKINS AVE, SUITE B, LAKE RONKONKOMA, NY 11779-9600
(631) 334-7884
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
012998
NY
103T00000X
Psychologist
012998
NY
103TC0700X
Clinical Psychologist
012998
NY
103TF0200X
Forensic Psychologist
Primary
012998
NY
103TR0400X
Rehabilitation Psychologist
012998
NY
Other
Enumeration date
03/21/2007
Last updated
09/11/2025
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