Provider Demographics
NPI:1417582552
Name:EXCELLENT NEUROLOGY SERVICE
Entity Type:Organization
Organization Name:EXCELLENT NEUROLOGY SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHENG
Authorized Official - Middle Name:
Authorized Official - Last Name:DU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-933-3687
Mailing Address - Street 1:3211 HUMBOLDT ST
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906-7224
Mailing Address - Country:US
Mailing Address - Phone:609-933-3687
Mailing Address - Fax:
Practice Address - Street 1:255 E 90TH DR
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-8144
Practice Address - Country:US
Practice Address - Phone:609-933-3687
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-09
Last Update Date:2020-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty