Provider Demographics
NPI:1558491373
Name:THROGGS NECK NEUROLOGICAL DIAGNOSIS PC
Entity Type:Organization
Organization Name:THROGGS NECK NEUROLOGICAL DIAGNOSIS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EVA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOUDAROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-204-0414
Mailing Address - Street 1:3146 E TREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-5706
Mailing Address - Country:US
Mailing Address - Phone:718-409-3433
Mailing Address - Fax:718-933-5321
Practice Address - Street 1:3146 E TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-5706
Practice Address - Country:US
Practice Address - Phone:718-409-3433
Practice Address - Fax:718-933-5321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00464888Medicaid
NY00464888Medicaid
NY23A571Medicare PIN
NYC06973Medicare UPIN