Provider Demographics
NPI:1659547263
Name:NEUROLOGY CLINICS & RESEARCH CENTER PA
Entity Type:Organization
Organization Name:NEUROLOGY CLINICS & RESEARCH CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ESHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIBRIA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:239-353-1555
Mailing Address - Street 1:5475 GOLDEN GATE PKWY STE 4
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34116-7529
Mailing Address - Country:US
Mailing Address - Phone:239-353-1555
Mailing Address - Fax:239-353-7001
Practice Address - Street 1:5475 GOLDEN GATE PKWY STE 4
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34116-7529
Practice Address - Country:US
Practice Address - Phone:239-353-1555
Practice Address - Fax:239-353-7001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-03
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0S00060262084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL82883OtherBLUE CROSS
FL82883OtherBLUE CROSS
FL82883Medicare PIN