Provider Demographics
NPI:1790926897
Name:NEUROLOGIQUE FOUNDATION, INC.
Entity Type:Organization
Organization Name:NEUROLOGIQUE FOUNDATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KANTOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-571-1198
Mailing Address - Street 1:4851 W HILLSBORO BLVD STE A1
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-4355
Mailing Address - Country:US
Mailing Address - Phone:561-571-1198
Mailing Address - Fax:754-333-8264
Practice Address - Street 1:4851 W HILLSBORO BLVD STE A1
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-4355
Practice Address - Country:US
Practice Address - Phone:561-571-1198
Practice Address - Fax:754-333-8264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-19
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95890261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center