Provider Demographics
NPI:1417197393
Name:SEMINOLE NEUROLOGY ASSOCIATES PA
Entity Type:Organization
Organization Name:SEMINOLE NEUROLOGY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BHUPINDER
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:MANGAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-324-5500
Mailing Address - Street 1:1403 MEDICAL PLAZA DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-1000
Mailing Address - Country:US
Mailing Address - Phone:407-324-5500
Mailing Address - Fax:407-324-5584
Practice Address - Street 1:1403 MEDICAL PLAZA DR
Practice Address - Street 2:SUITE 204
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-1000
Practice Address - Country:US
Practice Address - Phone:407-324-5500
Practice Address - Fax:407-324-5584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-04
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME34679174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL371305900Medicaid
FL371305900Medicaid
FLD84865Medicare UPIN