Provider Demographics
NPI:1790711356
Name:NEUROSCIENCE PRACTICE INSTITUTE PLLC
Entity Type:Organization
Organization Name:NEUROSCIENCE PRACTICE INSTITUTE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:W
Authorized Official - Last Name:COLINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-465-4195
Mailing Address - Street 1:1212 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103-3874
Mailing Address - Country:US
Mailing Address - Phone:239-465-4195
Mailing Address - Fax:239-330-4951
Practice Address - Street 1:1212 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-3874
Practice Address - Country:US
Practice Address - Phone:239-465-4195
Practice Address - Fax:239-330-4951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271671200Medicaid
FLU3144XMedicare PIN
FL271671200Medicaid