Provider Demographics
NPI:1558314997
Name:NEUROLOGICAL SPECIALIST, P.C.
Entity Type:Organization
Organization Name:NEUROLOGICAL SPECIALIST, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:TRUEDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-257-9302
Mailing Address - Street 1:2590 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06615-5838
Mailing Address - Country:US
Mailing Address - Phone:120-337-7598
Mailing Address - Fax:120-338-0053
Practice Address - Street 1:99 HAWLEY LN
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-1202
Practice Address - Country:US
Practice Address - Phone:203-377-4788
Practice Address - Fax:203-380-0531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0386632084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004084563Medicaid
CT=========OtherTAX ID#