Provider Demographics
NPI:1679726889
Name:NEUROLOGY SPECIALISTS OF JACKSONVILLE PA
Entity Type:Organization
Organization Name:NEUROLOGY SPECIALISTS OF JACKSONVILLE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:GROBLEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-514-9510
Mailing Address - Street 1:13245 ATLANTIC BLVD
Mailing Address - Street 2:SUITE 4-332
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-7121
Mailing Address - Country:US
Mailing Address - Phone:904-396-4666
Mailing Address - Fax:904-396-4777
Practice Address - Street 1:3627 UNIVERSITY BLVD S
Practice Address - Street 2:SUITE 255
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4230
Practice Address - Country:US
Practice Address - Phone:904-396-4666
Practice Address - Fax:904-396-4777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-31
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty