1811974330 NPI number — DEPARTMENT OF NEUROLOGY PROFESSIONAL SERVICES GROUP/SLRHC

Table of content: (NPI 1811974330)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811974330 NPI number — DEPARTMENT OF NEUROLOGY PROFESSIONAL SERVICES GROUP/SLRHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEPARTMENT OF NEUROLOGY PROFESSIONAL SERVICES GROUP/SLRHC
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:
1811974330
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 95000-2392
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19195-2392
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-523-7621
Provider Business Mailing Address Fax Number:
212-523-7494

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 10TH AVE
Provider Second Line Business Practice Location Address:
SUITE 3B20
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10019-1147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-523-7350
Provider Business Practice Location Address Fax Number:
212-523-7494
Provider Enumeration Date:
12/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
DELFINER
Authorized Official First Name:
JOEL
Authorized Official Middle Name:
STEPHEN
Authorized Official Title or Position:
CHAIRMAN/DEPARTMENT OF NEUROLOGY
Authorized Official Telephone Number:
212-523-6521

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)

  • Identifier: 02337680 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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