Provider Demographics
NPI:1457468548
Name:NEUROLOGY CLINIC PA
Entity Type:Organization
Organization Name:NEUROLOGY CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:PACKEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD MD
Authorized Official - Phone:321-984-9400
Mailing Address - Street 1:1333 PINE ST
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3116
Mailing Address - Country:US
Mailing Address - Phone:321-984-9400
Mailing Address - Fax:321-984-8782
Practice Address - Street 1:1333 PINE ST
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3116
Practice Address - Country:US
Practice Address - Phone:321-984-9400
Practice Address - Fax:321-984-8782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL33098Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER