Provider Demographics
NPI:1235195124
Name:ADVANCED NEUROLOGY & EMG, LLC
Entity Type:Organization
Organization Name:ADVANCED NEUROLOGY & EMG, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDAH
Authorized Official - Middle Name:R
Authorized Official - Last Name:LINDENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-332-0920
Mailing Address - Street 1:12000 MCCRACKEN RD
Mailing Address - Street 2:SUITE 357
Mailing Address - City:GARFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-2964
Mailing Address - Country:US
Mailing Address - Phone:216-332-0920
Mailing Address - Fax:216-332-0950
Practice Address - Street 1:12000 MCCRACKEN RD
Practice Address - Street 2:SUITE 357
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44125-2964
Practice Address - Country:US
Practice Address - Phone:216-332-0920
Practice Address - Fax:216-332-0950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2013-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0806442084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2709144Medicaid
OHDF0073Medicare PIN
OH2709144Medicaid