Provider Demographics
NPI:1790909893
Name:NEUROSPECIALTY ASSOCIATES PC
Entity Type:Organization
Organization Name:NEUROSPECIALTY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:NITKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-629-5600
Mailing Address - Street 1:8585 W 14TH AVE
Mailing Address - Street 2:STE A
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80215-4860
Mailing Address - Country:US
Mailing Address - Phone:303-629-5600
Mailing Address - Fax:303-623-5151
Practice Address - Street 1:8585 W 14TH AVE
Practice Address - Street 2:STE A
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-4860
Practice Address - Country:US
Practice Address - Phone:303-629-5600
Practice Address - Fax:303-623-5151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04015558Medicaid
CO04015558Medicaid