Provider Demographics
NPI:1760476139
Name:NEUROLOGY ASSOCIATES OF MESILLA VALLEY PC
Entity Type:Organization
Organization Name:NEUROLOGY ASSOCIATES OF MESILLA VALLEY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAVED
Authorized Official - Middle Name:
Authorized Official - Last Name:IQBAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:575-532-8561
Mailing Address - Street 1:3855 FOOTHILLS DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011
Mailing Address - Country:US
Mailing Address - Phone:575-532-8561
Mailing Address - Fax:575-532-8567
Practice Address - Street 1:3855 FOOTHILLS DRIVE
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011
Practice Address - Country:US
Practice Address - Phone:575-532-8561
Practice Address - Fax:575-532-8567
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEUROLOGY ASSOCIATES OF MESILLA VALLEY PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-08-31
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM922562084N0400X
TXK24992084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMK1326Medicaid
NMF0584Medicaid
NMK1326Medicaid
F53912Medicare UPIN