Provider Demographics
NPI:1073785143
Name:FIFTH AVENUE NEUROLOGY, PLLC
Entity Type:Organization
Organization Name:FIFTH AVENUE NEUROLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAUDE
Authorized Official - Middle Name:
Authorized Official - Last Name:MACALUSO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-675-3878
Mailing Address - Street 1:80 5TH AVE
Mailing Address - Street 2:SUITE 1605
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-8002
Mailing Address - Country:US
Mailing Address - Phone:212-675-3878
Mailing Address - Fax:212-647-1931
Practice Address - Street 1:80 5TH AVE
Practice Address - Street 2:SUITE 1605
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8002
Practice Address - Country:US
Practice Address - Phone:212-675-3878
Practice Address - Fax:212-647-1931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-29
Last Update Date:2008-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1633362084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4C1909OtherHEALTHNET
NY01075314Medicaid
NJ25MA05038400OtherMEDICAL LICENSE
2890688OtherAETNA
NY163336OtherMEDICAL LICENSE
P2666998OtherOXFORD
WEF431OtherMEDICARE
NJ25MA05038400OtherMEDICAL LICENSE
2890688OtherAETNA