Provider Demographics
NPI:1790924835
Name:ADVANCED NEUROLOGY OF THE PALM BEACHES, P.A.
Entity Type:Organization
Organization Name:ADVANCED NEUROLOGY OF THE PALM BEACHES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:M
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:561-626-1159
Mailing Address - Street 1:3375 BURNS RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4349
Mailing Address - Country:US
Mailing Address - Phone:561-626-1159
Mailing Address - Fax:561-626-5788
Practice Address - Street 1:3400 BURNS RD STE 101
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4352
Practice Address - Country:US
Practice Address - Phone:561-626-1159
Practice Address - Fax:561-275-7050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-12
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty