1346507365 NPI number — THE NEUROLOGY GROUP, LLP

Table of content: CHARYSSE JOHNSTON MANOUILOV MD (NPI 1265660203)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346507365 NPI number — THE NEUROLOGY GROUP, LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE NEUROLOGY GROUP, LLP
Provider Last Name:
Provider First Name:
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Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
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Provider Other Last Name:
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NPI Number Information

NPI Number:
1346507365
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 PATROON CREEK BLVD
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
ALBANY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12206-5013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-459-8106
Provider Business Mailing Address Fax Number:
518-489-6441

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5 SOUTHSIDE DR
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
CLIFTON PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12065-3870
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-459-8106
Provider Business Practice Location Address Fax Number:
518-489-6441
Provider Enumeration Date:
04/16/2012

Additional Information

Authorized Official

Authorized Official Last Name:
STOREY
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
518-459-8106

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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