Provider Demographics
NPI:1891787941
Name:NEUROLOGICAL INSTITUTE OF WESTERN PENNSYLVANIA PC
Entity Type:Organization
Organization Name:NEUROLOGICAL INSTITUTE OF WESTERN PENNSYLVANIA PC
Other - Org Name:N.I.W.P.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL SECRETARY
Authorized Official - Prefix:MS
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LIPKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-537-0885
Mailing Address - Street 1:433 FRYE FARM RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-6480
Mailing Address - Country:US
Mailing Address - Phone:724-537-0885
Mailing Address - Fax:724-532-1931
Practice Address - Street 1:433 FRYE FARM RD
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-6480
Practice Address - Country:US
Practice Address - Phone:724-537-0885
Practice Address - Fax:724-532-1931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011069800014Medicaid
PA045667Medicare PIN
PA0011069800014Medicaid