Provider Demographics
NPI:1023564481
Name:NEUROLOGICINC
Entity Type:Organization
Organization Name:NEUROLOGICINC
Other - Org Name:CONCUSSIONSRUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ASA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:ALBECZ
Authorized Official - Suffix:
Authorized Official - Credentials:REEGT RPSGT
Authorized Official - Phone:818-442-8350
Mailing Address - Street 1:15021 VENTURA BLVD
Mailing Address - Street 2:#393
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-2442
Mailing Address - Country:US
Mailing Address - Phone:818-442-8350
Mailing Address - Fax:
Practice Address - Street 1:630 S RAYMOND AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3278
Practice Address - Country:US
Practice Address - Phone:818-442-8350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-26
Last Update Date:2017-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4713246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Single Specialty