Provider Demographics
NPI:1730299272
Name:WEST PALM BEACH NEUROLOGY, P.A.
Entity Type:Organization
Organization Name:WEST PALM BEACH NEUROLOGY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMAL
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDEL-HALIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-422-1006
Mailing Address - Street 1:1035 S STATE ROAD 7 STE 214
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6137
Mailing Address - Country:US
Mailing Address - Phone:561-422-1006
Mailing Address - Fax:561-422-1078
Practice Address - Street 1:1035 S STATE ROAD 7 STE 214
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6137
Practice Address - Country:US
Practice Address - Phone:561-422-1006
Practice Address - Fax:561-422-1078
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST PALM BEACH NEUROLOGY, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-30
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85753174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL51436OtherBLUE CROSS BLUE SHIELD OF FLORIDA
FL265548900Medicaid
FL51436OtherBLUE CROSS BLUE SHIELD OF FLORIDA