Provider Demographics
NPI:1083721229
Name:BROOKLYN NEUROLOGICAL ASSOCIATES PC
Entity Type:Organization
Organization Name:BROOKLYN NEUROLOGICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:G
Authorized Official - Last Name:MANISCALCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-836-8800
Mailing Address - Street 1:117 70TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-1113
Mailing Address - Country:US
Mailing Address - Phone:718-836-8800
Mailing Address - Fax:718-836-0144
Practice Address - Street 1:117 70TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-1113
Practice Address - Country:US
Practice Address - Phone:718-836-8800
Practice Address - Fax:718-836-0144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW11161Medicare PIN