Provider Demographics
NPI:1225148166
Name:NEUROLOGY CENTERS OF PALM BEACH INC
Entity Type:Organization
Organization Name:NEUROLOGY CENTERS OF PALM BEACH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BANCHIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-392-2950
Mailing Address - Street 1:5458 TOWN CENTER ROAD
Mailing Address - Street 2:SUITE #22
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486
Mailing Address - Country:US
Mailing Address - Phone:561-392-2950
Mailing Address - Fax:561-391-2970
Practice Address - Street 1:5458 TOWN CENTER RD
Practice Address - Street 2:SUITE #22
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-1089
Practice Address - Country:US
Practice Address - Phone:561-392-2950
Practice Address - Fax:561-391-2970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0055218174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE34045Medicare UPIN
FL09342XMedicare ID - Type Unspecified