Provider Demographics
NPI:1134193279
Name:FAYETTE SPECIALTY ASSOCIATES-NEUROLOGY
Entity type:Organization
Organization Name:FAYETTE SPECIALTY ASSOCIATES-NEUROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:PULICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-434-1650
Mailing Address - Street 1:205 EASY ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-3128
Mailing Address - Country:US
Mailing Address - Phone:724-438-1464
Mailing Address - Fax:724-438-1548
Practice Address - Street 1:205 EASY ST
Practice Address - Street 2:SUITE 107
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-3128
Practice Address - Country:US
Practice Address - Phone:724-438-1464
Practice Address - Fax:724-438-1548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty