Provider Demographics
NPI:1114025152
Name:NEUROLOGIC ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:NEUROLOGIC ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:LERER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-223-3810
Mailing Address - Street 1:35 PEARL ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-2644
Mailing Address - Country:US
Mailing Address - Phone:860-223-3810
Mailing Address - Fax:860-229-2621
Practice Address - Street 1:35 PEARL ST
Practice Address - Street 2:SUITE 201
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051-2644
Practice Address - Country:US
Practice Address - Phone:860-223-3810
Practice Address - Fax:860-229-2621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTB39684Medicare UPIN
CT130000120Medicare ID - Type Unspecified
CTH60434Medicare UPIN
CT130000619Medicare ID - Type Unspecified
CTD98330Medicare UPIN
CTD76966Medicare UPIN
CT130000121Medicare ID - Type Unspecified
CT130000122Medicare ID - Type Unspecified