Provider Demographics
NPI:1124379714
Name:PIONEER NEUROLOGY AND SLEEP PC
Entity Type:Organization
Organization Name:PIONEER NEUROLOGY AND SLEEP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANI
Authorized Official - Middle Name:U
Authorized Official - Last Name:ATHREYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-736-1500
Mailing Address - Street 1:785 WILLIAMS ST
Mailing Address - Street 2:SUITE 324
Mailing Address - City:LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01106-2063
Mailing Address - Country:US
Mailing Address - Phone:413-736-1500
Mailing Address - Fax:413-736-1600
Practice Address - Street 1:299 CAREW ST
Practice Address - Street 2:SUITE 326
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-2301
Practice Address - Country:US
Practice Address - Phone:413-736-1500
Practice Address - Fax:413-736-1600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-24
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2089312084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAA39156OtherMEDICARE
MA2106108OtherMASS MEDICAID