Provider Demographics
NPI:1225240542
Name:GAZZA LAB NEUROLOGY, PSC
Entity Type:Organization
Organization Name:GAZZA LAB NEUROLOGY, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:U
Authorized Official - Last Name:NAIMOLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-886-2559
Mailing Address - Street 1:1830 HIGH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-1746
Mailing Address - Country:US
Mailing Address - Phone:270-886-2559
Mailing Address - Fax:270-886-0388
Practice Address - Street 1:1830 HIGH ST
Practice Address - Street 2:SUITE A
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-1746
Practice Address - Country:US
Practice Address - Phone:270-886-2559
Practice Address - Fax:270-886-0388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY308822084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty