Provider Demographics
NPI:1134463599
Name:NEUROSCIENCE RESOURCES PLLC
Entity Type:Organization
Organization Name:NEUROSCIENCE RESOURCES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GOVERNING AUTHORITY
Authorized Official - Prefix:DR
Authorized Official - First Name:BRATISLAV
Authorized Official - Middle Name:
Authorized Official - Last Name:VELIMIROVIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:917-549-7710
Mailing Address - Street 1:1031 W NEWPORT AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-1537
Mailing Address - Country:US
Mailing Address - Phone:917-549-7710
Mailing Address - Fax:
Practice Address - Street 1:6025 METROPOLITAN DR STE 205
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-2409
Practice Address - Country:US
Practice Address - Phone:915-209-2597
Practice Address - Fax:800-886-8616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-24
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP4000207T00000X, 2084V0102X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular NeurologyGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty