Provider Demographics
NPI:1083764773
Name:DENT NEUORLOGIC INSTITUTE
Entity Type:Organization
Organization Name:DENT NEUORLOGIC INSTITUTE
Other - Org Name:DENT NEUROLOGIC GROUP LLP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:PALMIERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-250-6035
Mailing Address - Street 1:3980 SHERIDAN DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-1727
Mailing Address - Country:US
Mailing Address - Phone:716-250-2000
Mailing Address - Fax:716-250-2040
Practice Address - Street 1:200 STERLING DR
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1558
Practice Address - Country:US
Practice Address - Phone:716-250-2000
Practice Address - Fax:716-250-0320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02099434Medicaid
NY02099434Medicaid