Provider Demographics
NPI:1467037952
Name:NEAL, WILLIE EDWARD (CRPA)
Entity Type:Individual
Prefix:MR
First Name:WILLIE
Middle Name:EDWARD
Last Name:NEAL
Suffix:
Gender:M
Credentials:CRPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2976 NORTHERN BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-2829
Mailing Address - Country:US
Mailing Address - Phone:212-691-7554
Mailing Address - Fax:
Practice Address - Street 1:2976 NORTHERN BLVD FL 2
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-2829
Practice Address - Country:US
Practice Address - Phone:212-691-7554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP4766175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist