Provider Demographics
NPI:1568559243
Name:NEUROLOGICAL NEURODIAGNOSTIC ASSOCIATES
Entity Type:Organization
Organization Name:NEUROLOGICAL NEURODIAGNOSTIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:H
Authorized Official - Middle Name:RONALD
Authorized Official - Last Name:BERK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-682-2536
Mailing Address - Street 1:4815 LIBERTY AVE
Mailing Address - Street 2:SUITE 426
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-2156
Mailing Address - Country:US
Mailing Address - Phone:412-682-2536
Mailing Address - Fax:412-682-0214
Practice Address - Street 1:4815 LIBERTY AVE
Practice Address - Street 2:SUITE 426
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-2156
Practice Address - Country:US
Practice Address - Phone:412-682-2536
Practice Address - Fax:412-682-0214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006476360004Medicaid
PA0006476360004Medicaid