Provider Demographics
NPI:1265425409
Name:NORTHEAST NEUROLOGY ASSOCIATES
Entity type:Organization
Organization Name:NORTHEAST NEUROLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KISHORE
Authorized Official - Middle Name:N
Authorized Official - Last Name:RANADE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-279-9000
Mailing Address - Street 1:670 STONELEIGH AVE
Mailing Address - Street 2:STE 202 BLDG 665
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-3997
Mailing Address - Country:US
Mailing Address - Phone:845-279-9000
Mailing Address - Fax:845-279-4141
Practice Address - Street 1:670 STONELEIGH AVE
Practice Address - Street 2:STE 202 BLDG 665
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512-3997
Practice Address - Country:US
Practice Address - Phone:845-279-9000
Practice Address - Fax:845-279-4141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0297052084N0400X
NY16961912084N0400X
NY19553812084N0400X
NY16938812084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W34623Medicare ID - Type Unspecified