Provider Demographics
NPI:1740595222
Name:NEUROLOGY AND PAIN MANAGEMENT CENTER
Entity Type:Organization
Organization Name:NEUROLOGY AND PAIN MANAGEMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FUHAI
Authorized Official - Middle Name:
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-296-8494
Mailing Address - Street 1:104 BENNETT AVE
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:MILFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18337-9759
Mailing Address - Country:US
Mailing Address - Phone:570-296-8494
Mailing Address - Fax:570-296-8493
Practice Address - Street 1:104 BENNETT AVE
Practice Address - Street 2:SUITE 1B
Practice Address - City:MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18337-9759
Practice Address - Country:US
Practice Address - Phone:570-296-8494
Practice Address - Fax:570-296-8493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4289632084D0003X, 2084N0400X, 2084P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2084D0003XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyDiagnostic NeuroimagingGroup - Multi-Specialty
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1016960930002Medicaid