Provider Demographics
NPI:1255353157
Name:COMPLEX SPINE AND NEUROLOGICAL SURGERY PC
Entity type:Organization
Organization Name:COMPLEX SPINE AND NEUROLOGICAL SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:AMED
Authorized Official - Middle Name:
Authorized Official - Last Name:RAWANDUZY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-771-7335
Mailing Address - Street 1:PO BOX 1240
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-9240
Mailing Address - Country:US
Mailing Address - Phone:914-771-7335
Mailing Address - Fax:914-771-7338
Practice Address - Street 1:421 HUGUENOT ST
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-7004
Practice Address - Country:US
Practice Address - Phone:914-235-3526
Practice Address - Fax:914-771-7339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199196207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01710287Medicaid
NY01710287Medicaid
G46792Medicare UPIN