Provider Demographics
NPI:1528409885
Name:NEURO MANAGEMENT, PC
Entity Type:Organization
Organization Name:NEURO MANAGEMENT, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD, PHD
Authorized Official - Prefix:
Authorized Official - First Name:SUANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MALLENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-381-6308
Mailing Address - Street 1:2 EAST AVE
Mailing Address - Street 2:SUITE 215
Mailing Address - City:LARCHMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10538-2462
Mailing Address - Country:US
Mailing Address - Phone:914-381-6308
Mailing Address - Fax:914-381-2633
Practice Address - Street 1:2 EAST AVE
Practice Address - Street 2:SUITE 215
Practice Address - City:LARCHMONT
Practice Address - State:NY
Practice Address - Zip Code:10538-2462
Practice Address - Country:US
Practice Address - Phone:914-381-6308
Practice Address - Fax:914-381-2633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY183699261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health