Provider Demographics
NPI:1578097945
Name:NEUROSURGICAL SPINE GROUP, INC
Entity Type:Organization
Organization Name:NEUROSURGICAL SPINE GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROSURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:VOKSHOOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-817-0898
Mailing Address - Street 1:3548 STONEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-5007
Mailing Address - Country:US
Mailing Address - Phone:818-817-0898
Mailing Address - Fax:
Practice Address - Street 1:7230 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 503
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-1907
Practice Address - Country:US
Practice Address - Phone:800-899-0101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMIR VOKSHOOR MD MEDCORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA078293207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH67603Medicare UPIN