Provider Demographics
NPI:1417157660
Name:NEUROLOGY CONSULTANTS LLC
Entity Type:Organization
Organization Name:NEUROLOGY CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:P
Authorized Official - Last Name:GASECKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:801-446-8156
Mailing Address - Street 1:2204 HIGH RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84092-4859
Mailing Address - Country:US
Mailing Address - Phone:801-446-8156
Mailing Address - Fax:801-446-8393
Practice Address - Street 1:8706 S 700 E
Practice Address - Street 2:SUITE 200
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-1807
Practice Address - Country:US
Practice Address - Phone:801-446-8156
Practice Address - Fax:810-446-8393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT36260312052084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTF86992Medicare UPIN
UT000057210Medicare PIN