Provider Demographics
NPI:1073608832
Name:METROPOLITAN NEURO BEHAVIORAL INSTITUTE PLLC
Entity Type:Organization
Organization Name:METROPOLITAN NEURO BEHAVIORAL INSTITUTE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:FNU
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIYANKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-490-2067
Mailing Address - Street 1:70 N MCCLINTOCK DR STE 4
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-3711
Mailing Address - Country:US
Mailing Address - Phone:480-464-4431
Mailing Address - Fax:480-464-2338
Practice Address - Street 1:4055 W CHANDLER BLVD
Practice Address - Street 2:SUITE #5
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-3700
Practice Address - Country:US
Practice Address - Phone:480-464-4431
Practice Address - Fax:480-464-2338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17900174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1659364396OtherDR'S NPI #
AZ118426Medicare PIN
AZ118459Medicare PIN
AZ1659364396OtherDR'S NPI #