Provider Demographics
NPI:1265490502
Name:NEUROLOGICAL SPECIALTIES NEUROSURGERY PA
Entity Type:Organization
Organization Name:NEUROLOGICAL SPECIALTIES NEUROSURGERY PA
Other - Org Name:MANISCALCO AND NEWMAN MDS PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:MANISCALCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-876-6321
Mailing Address - Street 1:2816 W VIRGINIA AVE
Mailing Address - Street 2:NEUROLOGICAL SPECIALTIES NEUROSURGERY PA
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6330
Mailing Address - Country:US
Mailing Address - Phone:813-876-6321
Mailing Address - Fax:813-870-0350
Practice Address - Street 1:2816 W VIRGINIA AVE
Practice Address - Street 2:NEUROLOGICAL SPECIALTIES NEUROSURGERY PA
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6330
Practice Address - Country:US
Practice Address - Phone:813-876-6321
Practice Address - Fax:813-870-0350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL98598OtherBCBS OF FLORIDA
=========OtherTAX ID
FL98598OtherBCBS OF FLORIDA