Provider Demographics
NPI:1134293699
Name:NEUROLOGICAL CONSULTANTS OF VIRGINIA BEACH
Entity type:Organization
Organization Name:NEUROLOGICAL CONSULTANTS OF VIRGINIA BEACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SIDNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MALLENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-481-1444
Mailing Address - Street 1:1008 FIRST COLONIAL RD
Mailing Address - Street 2:#101
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VT
Mailing Address - Zip Code:23454
Mailing Address - Country:US
Mailing Address - Phone:757-481-1444
Mailing Address - Fax:757-481-1377
Practice Address - Street 1:1008 FIRST COLONIAL RD
Practice Address - Street 2:#101
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VT
Practice Address - Zip Code:23454
Practice Address - Country:US
Practice Address - Phone:757-481-1444
Practice Address - Fax:757-481-1377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VACI7248OtherRAILROAD MEDICARE
VACI7248OtherRAILROAD MEDICARE