Provider Demographics
NPI:1932470887
Name:ADVANCED NORTHSHORE NEUROSURGICAL INSTITUTE
Entity Type:Organization
Organization Name:ADVANCED NORTHSHORE NEUROSURGICAL INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ALMUBASLAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-400-3210
Mailing Address - Street 1:71380 HIGHWAY 21
Mailing Address - Street 2:104
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-7245
Mailing Address - Country:US
Mailing Address - Phone:985-400-3210
Mailing Address - Fax:855-553-6931
Practice Address - Street 1:71380 HIGHWAY 21
Practice Address - Street 2:104
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7245
Practice Address - Country:US
Practice Address - Phone:985-400-3210
Practice Address - Fax:855-553-6931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-24
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty