Provider Demographics
NPI:1407268808
Name:ADVANTAGE NEUROLOGY GROUP LLC
Entity Type:Organization
Organization Name:ADVANTAGE NEUROLOGY GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-992-2259
Mailing Address - Street 1:6810 N STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-4304
Mailing Address - Country:US
Mailing Address - Phone:888-992-2259
Mailing Address - Fax:888-613-0761
Practice Address - Street 1:6810 N STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-4304
Practice Address - Country:US
Practice Address - Phone:888-992-2259
Practice Address - Fax:888-613-0761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-20
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME31479174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty