Provider Demographics
NPI:1811235450
Name:AMS NEUROLOGY
Entity Type:Organization
Organization Name:AMS NEUROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:NIESEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-599-7600
Mailing Address - Street 1:960 E GREEN ST
Mailing Address - Street 2:STE L11
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-2412
Mailing Address - Country:US
Mailing Address - Phone:626-599-7600
Mailing Address - Fax:626-599-7601
Practice Address - Street 1:960 E GREEN ST
Practice Address - Street 2:STE L11
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-2412
Practice Address - Country:US
Practice Address - Phone:626-599-7600
Practice Address - Fax:626-599-7601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54329174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty