1033574140 NPI number — NEUROLOGY CHILDREN'S LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033574140 NPI number — NEUROLOGY CHILDREN'S LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEUROLOGY CHILDREN'S LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033574140
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2984 ALAFAYA TRL
Provider Second Line Business Mailing Address:
SUITE 2020
Provider Business Mailing Address City Name:
OVIEDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32765-7628
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-278-2401
Provider Business Mailing Address Fax Number:
407-278-2402

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2984 ALAFAYA TRL
Provider Second Line Business Practice Location Address:
SUITE 2020
Provider Business Practice Location Address City Name:
OVIEDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32765-7628
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-278-2401
Provider Business Practice Location Address Fax Number:
407-278-2402
Provider Enumeration Date:
12/17/2015

Additional Information

Authorized Official

Authorized Official Last Name:
FALCAO
Authorized Official First Name:
GERMANO
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
407-278-2401

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  ME125808 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 015902200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 016367000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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