Provider Demographics
NPI:1952687832
Name:NEUROLOGY & NEURODIAGNOSTIC CONSULTANTS
Entity Type:Organization
Organization Name:NEUROLOGY & NEURODIAGNOSTIC CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:LATA
Authorized Official - Middle Name:
Authorized Official - Last Name:BANSAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-228-0220
Mailing Address - Street 1:2909 N. ORANGE AVE
Mailing Address - Street 2:#109
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804
Mailing Address - Country:US
Mailing Address - Phone:407-228-0220
Mailing Address - Fax:407-228-4668
Practice Address - Street 1:2909 N ORANGE AVENUE,
Practice Address - Street 2:SUITE 109
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804
Practice Address - Country:US
Practice Address - Phone:407-228-0220
Practice Address - Fax:407-228-4668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-24
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME580382084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty