Provider Demographics
NPI:1326287202
Name:CHILDREN'S NEUROLOGY SERVICES, LLC
Entity Type:Organization
Organization Name:CHILDREN'S NEUROLOGY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:D
Authorized Official - Last Name:KLEIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-635-3600
Mailing Address - Street 1:147 SAYBROOK RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-4704
Mailing Address - Country:US
Mailing Address - Phone:860-635-3600
Mailing Address - Fax:860-635-2300
Practice Address - Street 1:147 SAYBROOK RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-4704
Practice Address - Country:US
Practice Address - Phone:860-635-3600
Practice Address - Fax:860-635-2300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-17
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT031852174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty