Provider Demographics
NPI:1770850661
Name:CULICCHIA NEUROLOGICAL CLINIC
Entity Type:Organization
Organization Name:CULICCHIA NEUROLOGICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DARLA
Authorized Official - Middle Name:P
Authorized Official - Last Name:ROST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-340-6976
Mailing Address - Street 1:1111 MEDICAL CENTER BLVD
Mailing Address - Street 2:STE S750
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-3151
Mailing Address - Country:US
Mailing Address - Phone:504-340-6976
Mailing Address - Fax:
Practice Address - Street 1:1111 MEDICAL CENTER BLVD
Practice Address - Street 2:STE S750
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3151
Practice Address - Country:US
Practice Address - Phone:504-340-6976
Practice Address - Fax:504-349-6775
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CNC PHYSICAL THERAPY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1797626Medicaid
LA5B422Medicare PIN