Provider Demographics
NPI:1164727277
Name:NEUROLOGY CENTER OF PHILADELPHIA INC.
Entity Type:Organization
Organization Name:NEUROLOGY CENTER OF PHILADELPHIA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIKHAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAMAYEV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-870-2551
Mailing Address - Street 1:9922 ROOSEVELT BLVD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-1705
Mailing Address - Country:US
Mailing Address - Phone:215-870-2551
Mailing Address - Fax:
Practice Address - Street 1:9922 ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-1705
Practice Address - Country:US
Practice Address - Phone:215-870-2551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-20
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4323082084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty