Provider Demographics
NPI:1114789484
Name:MEDICAL NEUROLOGY PLLC
Entity Type:Organization
Organization Name:MEDICAL NEUROLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VESNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MICIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-370-3789
Mailing Address - Street 1:105 W 125TH ST FRNT 1-1149
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-4444
Mailing Address - Country:US
Mailing Address - Phone:646-960-1085
Mailing Address - Fax:646-607-6871
Practice Address - Street 1:245 5TH AVE FL 3
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-8728
Practice Address - Country:US
Practice Address - Phone:646-960-1085
Practice Address - Fax:646-607-6871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty