Provider Demographics
NPI:1033662127
Name:MIDTOWN NEUROLOGICAL PC
Entity Type:Organization
Organization Name:MIDTOWN NEUROLOGICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ENRICO
Authorized Official - Middle Name:
Authorized Official - Last Name:FAZZINI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:212-983-1370
Mailing Address - Street 1:353 LEXINGTON AVE
Mailing Address - Street 2:SUITE 1001
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-0941
Mailing Address - Country:US
Mailing Address - Phone:212-983-1370
Mailing Address - Fax:
Practice Address - Street 1:353 LEXINGTON AVE
Practice Address - Street 2:SUITE 1001
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-0941
Practice Address - Country:US
Practice Address - Phone:212-983-1370
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY157518261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty