Provider Demographics
NPI:1356651202
Name:DEPARTMENT OF NEUROSURGERY, PLLC
Entity Type:Organization
Organization Name:DEPARTMENT OF NEUROSURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:P. CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:GARELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-278-5687
Mailing Address - Street 1:670 STONELEIGH AVE.
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512
Mailing Address - Country:US
Mailing Address - Phone:845-278-5687
Mailing Address - Fax:
Practice Address - Street 1:670 STONELEIGH AVE.
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512
Practice Address - Country:US
Practice Address - Phone:845-278-5687
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-13
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY239955207T00000X
251F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
No251F00000XAgenciesHome InfusionGroup - Single Specialty