Provider Demographics
NPI:1275720278
Name:SPINE AND PERIPHERAL NEUROCARE, PC
Entity Type:Organization
Organization Name:SPINE AND PERIPHERAL NEUROCARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:W
Authorized Official - Last Name:HEISE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-988-4815
Mailing Address - Street 1:420 E 72ND ST
Mailing Address - Street 2:SUITE 1J
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4650
Mailing Address - Country:US
Mailing Address - Phone:212-988-4815
Mailing Address - Fax:212-988-1122
Practice Address - Street 1:420 E 72ND ST
Practice Address - Street 2:SUITE 1J
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4650
Practice Address - Country:US
Practice Address - Phone:212-988-4815
Practice Address - Fax:212-988-1122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1855472084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty