Provider Demographics
NPI:1255396875
Name:CHILD NEUROLOGY CENTER OF ORLANDO, P.A.
Entity type:Organization
Organization Name:CHILD NEUROLOGY CENTER OF ORLANDO, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRSIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JASNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOJIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-649-1848
Mailing Address - Street 1:6000 TURKEY LAKE ROAD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819
Mailing Address - Country:US
Mailing Address - Phone:407-649-1848
Mailing Address - Fax:407-649-1979
Practice Address - Street 1:6000 TURKEY LAKE ROAD
Practice Address - Street 2:SUITE 205
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819
Practice Address - Country:US
Practice Address - Phone:407-649-1848
Practice Address - Fax:407-649-1979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPEDIATRIC NEUROLOGY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty