1891876199 NPI number — ALL NEUROLOGICAL SERVICES PC

Table of content: (NPI 1891876199)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891876199 NPI number — ALL NEUROLOGICAL SERVICES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALL NEUROLOGICAL SERVICES PC
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:
1891876199
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1041 ARCADIAN WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT LEE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07024-6349
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-376-3200
Provider Business Mailing Address Fax Number:
718-376-1136

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2310 65TH ST
Provider Second Line Business Practice Location Address:
1ST FLOOR
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11204-4088
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-376-3200
Provider Business Practice Location Address Fax Number:
718-336-1136
Provider Enumeration Date:
10/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KHELEMSKY
Authorized Official First Name:
IGOR
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DOCTOR
Authorized Official Telephone Number:
718-376-3200

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  196963-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 02710814 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 674300 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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