Provider Demographics
NPI:1477845683
Name:EL PASO NEUROLOGICAL INSTITUTE, PA
Entity Type:Organization
Organization Name:EL PASO NEUROLOGICAL INSTITUTE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/MD
Authorized Official - Prefix:
Authorized Official - First Name:KWAZI
Authorized Official - Middle Name:
Authorized Official - Last Name:ADZOTOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-504-6890
Mailing Address - Street 1:5959 GATEWAY BLVD W
Mailing Address - Street 2:120
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-3331
Mailing Address - Country:US
Mailing Address - Phone:915-779-1716
Mailing Address - Fax:915-771-6496
Practice Address - Street 1:3270 JOE BATTLE BLVD
Practice Address - Street 2:235
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-2639
Practice Address - Country:US
Practice Address - Phone:915-504-6890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-05
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN8602207R00000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty