Provider Demographics
NPI:1124573522
Name:PEDIATRIC NEUROLOGY PC
Entity Type:Organization
Organization Name:PEDIATRIC NEUROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:MAJA
Authorized Official - Middle Name:
Authorized Official - Last Name:ILIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-358-1162
Mailing Address - Street 1:8 MURRAY HILL RD
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-2804
Mailing Address - Country:US
Mailing Address - Phone:914-358-1162
Mailing Address - Fax:914-368-8343
Practice Address - Street 1:210 N CENTRAL AVE STE 250
Practice Address - Street 2:
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530-1949
Practice Address - Country:US
Practice Address - Phone:914-358-1162
Practice Address - Fax:914-368-8343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-16
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2592492084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Single Specialty