Provider Demographics
NPI: | 1619472271 |
---|---|
Name: | MOVING BRAINS NEUROLOGICAL CARE, PLLC |
Entity Type: | Organization |
Organization Name: | MOVING BRAINS NEUROLOGICAL CARE, PLLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER/AUTHORIZED OFFICIAL |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | JOSE |
Authorized Official - Middle Name: | CARLOS |
Authorized Official - Last Name: | CABASSA |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 646-952-0007 |
Mailing Address - Street 1: | 205 E 111TH ST |
Mailing Address - Street 2: | |
Mailing Address - City: | NEW YORK |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 10029-2901 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 646-952-0007 |
Mailing Address - Fax: | 646-864-0237 |
Practice Address - Street 1: | 205 E 111TH ST |
Practice Address - Street 2: | |
Practice Address - City: | NEW YORK |
Practice Address - State: | NY |
Practice Address - Zip Code: | 10029-2901 |
Practice Address - Country: | US |
Practice Address - Phone: | 646-864-0213 |
Practice Address - Fax: | 646-864-0237 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2018-03-27 |
Last Update Date: | 2021-03-25 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Single Specialty |