Provider Demographics
NPI:1477607919
Name:MEDIA NEUROLOGY PC
Entity Type:Organization
Organization Name:MEDIA NEUROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GERMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAUFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-787-1525
Mailing Address - Street 1:2000 KINGS HIGHWAY
Mailing Address - Street 2:SUITE 1E
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1445
Mailing Address - Country:US
Mailing Address - Phone:718-787-1525
Mailing Address - Fax:718-787-1530
Practice Address - Street 1:2000 KINGS HIGHWAY
Practice Address - Street 2:SUITE 1E
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1445
Practice Address - Country:US
Practice Address - Phone:718-787-1525
Practice Address - Fax:718-787-1530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2015022084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000210738703OtherUHC
NY01659609Medicaid
P2525397OtherOXFORD
G28666Medicare UPIN
P2525397OtherOXFORD