Provider Demographics
NPI:1689227076
Name:GNI NEURO CRITICAL CARE LLC
Entity Type:Organization
Organization Name:GNI NEURO CRITICAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:S. AUSIM
Authorized Official - Middle Name:
Authorized Official - Last Name:AZIZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:844-464-6387
Mailing Address - Street 1:ONE MEDICAL CENTER BLVD.
Mailing Address - Street 2:ACP, SUITE 232
Mailing Address - City:CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19013-3902
Mailing Address - Country:US
Mailing Address - Phone:844-464-6387
Mailing Address - Fax:215-239-3037
Practice Address - Street 1:ONE MEDICAL CENTER BLVD.
Practice Address - Street 2:ACP, SUITE 232
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013-3902
Practice Address - Country:US
Practice Address - Phone:844-464-6387
Practice Address - Fax:215-239-3037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-24
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2084A2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurocritical CareGroup - Multi-Specialty