Provider Demographics
NPI:1205378163
Name:NEUROLOGICAL GROUP, PC
Entity Type:Organization
Organization Name:NEUROLOGICAL GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDEN
Authorized Official - Prefix:
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:I
Authorized Official - Last Name:RADIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-443-1891
Mailing Address - Street 1:350 MONTAUK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-4730
Mailing Address - Country:US
Mailing Address - Phone:860-443-1891
Mailing Address - Fax:860-443-2980
Practice Address - Street 1:350 MONTAUK AVE
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-4730
Practice Address - Country:US
Practice Address - Phone:860-443-1891
Practice Address - Fax:860-443-2980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-09
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003463363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty