Provider Demographics
NPI:1871646414
Name:SOUTHERN COUNTIES NEUROSURGICAL ASSOCIATES MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:SOUTHERN COUNTIES NEUROSURGICAL ASSOCIATES MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:
Authorized Official - Last Name:FINEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-535-9552
Mailing Address - Street 1:630 S RAYMOND AVE
Mailing Address - Street 2:ST 301
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3278
Mailing Address - Country:US
Mailing Address - Phone:626-535-9552
Mailing Address - Fax:626-535-9505
Practice Address - Street 1:630 S RAYMOND AVE
Practice Address - Street 2:ST 301
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3278
Practice Address - Country:US
Practice Address - Phone:626-535-9552
Practice Address - Fax:626-535-9505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55380207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14008Medicare ID - Type UnspecifiedGRP PROVIDER #