Provider Demographics
NPI:1659410918
Name:NEUROLOGY SPECIALISTS OF JUPITER PA
Entity Type:Organization
Organization Name:NEUROLOGY SPECIALISTS OF JUPITER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:STAFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:561-627-3381
Mailing Address - Street 1:601 UNIVERSITY BLVD
Mailing Address - Street 2:SUITE 102 101
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7816
Mailing Address - Country:US
Mailing Address - Phone:561-627-3381
Mailing Address - Fax:561-627-3381
Practice Address - Street 1:601 UNIVERSITY BLVD.
Practice Address - Street 2:SUITE 102 101
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7801
Practice Address - Country:US
Practice Address - Phone:561-627-3381
Practice Address - Fax:561-627-3384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1490Medicare ID - Type Unspecified