Provider Demographics
NPI:1700823150
Name:NEUROSURGICAL ASSOCIATES PC
Entity Type:Organization
Organization Name:NEUROSURGICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHAN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:LANGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-522-7121
Mailing Address - Street 1:1000 ASYLUM AVE
Mailing Address - Street 2:SUITE 3208
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-1770
Mailing Address - Country:US
Mailing Address - Phone:860-522-7121
Mailing Address - Fax:860-244-3516
Practice Address - Street 1:1000 ASYLUM AVE
Practice Address - Street 2:SUITE 3208
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1770
Practice Address - Country:US
Practice Address - Phone:860-522-7121
Practice Address - Fax:860-244-3516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C00283Medicare PIN