Provider Demographics
NPI:1720380009
Name:V.L.Y NEUROPSYCH GROUP P.A.
Entity Type:Organization
Organization Name:V.L.Y NEUROPSYCH GROUP P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VLADISLAV
Authorized Official - Middle Name:L
Authorized Official - Last Name:YEGANOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-824-9100
Mailing Address - Street 1:712 N WASHINGTON AVE
Mailing Address - Street 2:SUITE # 411
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1619
Mailing Address - Country:US
Mailing Address - Phone:214-824-9100
Mailing Address - Fax:214-824-9101
Practice Address - Street 1:712 N WASHINGTON AVE
Practice Address - Street 2:SUITE # 411
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1619
Practice Address - Country:US
Practice Address - Phone:214-824-9100
Practice Address - Fax:214-824-9101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-19
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX166625701Medicaid
I08928OtherUPIN
TX166625701Medicaid