Provider Demographics
NPI:1710480496
Name:LEVEL ONE NEUROLOGY, LLC
Entity Type:Organization
Organization Name:LEVEL ONE NEUROLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAHOS
Authorized Official - Suffix:
Authorized Official - Credentials:BUSINESS OFFICE
Authorized Official - Phone:201-370-1791
Mailing Address - Street 1:163 BOGERTS MILL RD
Mailing Address - Street 2:
Mailing Address - City:HARRINGTON PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07640-1711
Mailing Address - Country:US
Mailing Address - Phone:201-370-1791
Mailing Address - Fax:
Practice Address - Street 1:19 BAKER AVE STE 301
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1385
Practice Address - Country:US
Practice Address - Phone:845-483-5951
Practice Address - Fax:845-483-5302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-09
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY187561-1207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty